Litchinko Alexis, Meyer Jeremy, Buhler Leo, Ris Frederic, Adamina Michel
Division of Digestive Surgery, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211 , Genève 14, Switzerland.
Faculty of Science, HFR Fribourg - Cantonal Hospital, Fribourg, CH-1711, Switzerland.
Langenbecks Arch Surg. 2025 Jul 1;410(1):202. doi: 10.1007/s00423-025-03786-6.
Modern surgical guidance in laparoscopic colon cancer procedures could be enhanced by visualizing lymphatic flow during surgery, already helping surgeons in determining the precise extent of digestive resection and could be useful in lymphadenectomy. Related to oncological procedure, lymphadenectomy is mandatory to assess the extension of the disease. To explore this approach, the objective of this review is to examine the use of indocyanine green fluorescence imaging for real-time in vivo identification of lymphatic flow and especially sentinel nodes in patients undergoing elective surgery for colorectal cancer.
A systematic review was conducted to identify relevant studies on sentinel node mapping using indocyanine green (ICG) in colorectal cancer surgery. A comprehensive search was performed in electronic databases including PubMed, Embase, and Cochrane Library from inception to December 2024. The search strategy incorporated relevant keywords and MeSH terms, combining variations of "colorectal neoplasms," "sentinel lymph node," "indocyanine green," and related terms. The search was limited to articles published in English language.
A total of 405 studies were identified across all databases. After screening, 45 full-text articles were assessed for eligibility, and 12 studies were ultimately included in the systematic review. ICG-FI has not yet demonstrated superiority over the standard blue dye technique. Moreover, a notable heterogeneity exists among the reported studies concerning ICG dosage, injection methods and the definition of positive LN status for sensitivity calculations, making direct comparisons challenging.
Despite the potential shown with other surgical oncological resections, ICG-FI requires further investigation and standardization in protocols and indications to fully harness its capabilities for SLN detection in CRC, especially metastatic nodes. Larger patient populations should be considered in future research to comprehensively assess its efficacy. This systematic review highlights the heterogeneity and limitations of current evidence regarding ICG-FI for SLN detection in colorectal cancer. While preliminary results are encouraging, further well-designed prospective trials are required before routine clinical implementation can be recommended.
在腹腔镜结肠癌手术中，通过可视化手术过程中的淋巴流动可加强现代手术指导，这已有助于外科医生确定消化切除的精确范围，并且在淋巴结清扫术中可能有用。与肿瘤手术相关，淋巴结清扫对于评估疾病的范围是必不可少的。为了探索这种方法，本综述的目的是研究吲哚菁绿荧光成像在接受择期结直肠癌手术患者中用于实时体内识别淋巴流动尤其是前哨淋巴结的应用。
进行了一项系统综述，以确定在结直肠癌手术中使用吲哚菁绿（ICG）进行前哨淋巴结定位的相关研究。从数据库建立至2024年12月，在包括PubMed、Embase和Cochrane图书馆在内的电子数据库中进行了全面搜索。搜索策略纳入了相关关键词和医学主题词，结合了“结直肠肿瘤”“前哨淋巴结”“吲哚菁绿”及相关术语的变体。搜索仅限于以英文发表的文章。
在所有数据库中总共识别出405项研究。筛选后，对45篇全文文章进行了资格评估，最终12项研究被纳入系统综述。吲哚菁绿荧光成像尚未显示出优于标准蓝色染料技术。此外，在报告的研究中，关于吲哚菁绿剂量、注射方法以及用于敏感性计算的阳性淋巴结状态定义存在显著异质性，使得直接比较具有挑战性。
尽管吲哚菁绿荧光成像在其他外科肿瘤切除术中显示出潜力，但在方案和适应症方面需要进一步研究和标准化，以充分发挥其在结直肠癌中检测前哨淋巴结（尤其是转移淋巴结）的能力。未来研究应考虑纳入更大的患者群体以全面评估其疗效。本系统综述突出了当前关于吲哚菁绿荧光成像用于结直肠癌前哨淋巴结检测证据的异质性和局限性。虽然初步结果令人鼓舞，但在推荐常规临床应用之前，还需要进一步精心设计的前瞻性试验。
