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Background <p>Complete mesocolic excision and D3 lymphadenectomy are essential for curative colon cancer surgery. However, identifying the optimal mesenteric dissection plane remains challenging. Near-infrared (NIR) fluorescence imaging using indocyanine green (ICG) enables real-time visualization of lymphatic flow, potentially enhancing surgical precision. This study aimed to evaluate the utility of ICG-NIR fluorescence guidance for precise lymph node dissection during laparoscopic colectomy for colon cancer.</p> Methods <p>Patients with stage II–III colon cancer who underwent laparoscopic colectomy with D3 lymphadenectomy, with (NIR group, <i>n</i> = 62) or without (non-NIR group, <i>n</i> = 65) ICG guidance, were retrospectively compared using propensity score matching. ICG (2.5&#xa0;mg/mL) was injected submucosally near the tumor preoperatively. Fluorescent lymph nodes were identified and dissected intraoperatively. Outcomes included 3-year relapse-free survival, total and apical lymph node yields, blood loss, and postoperative complications.</p> Results <p>After propensity score matching, 50 patients were included in each group. The total lymph node yield tended to be higher in the NIR group (27.6 ± 11.3 vs. 23.4 ± 9.4; <i>p</i> = 0.052), whereas the number of apical lymph nodes harvested was significantly greater (6.8 ± 4.3 vs. 3.3 ± 2.5; <i>p</i> &lt; 0.001). Operative time was comparable between groups (315 [178–934] vs. 291.5 [146–521] min; <i>p</i> = 0.236), whereas estimated blood loss was significantly lower in the NIR group (5 [5–220] vs. 60 [5–825] mL; <i>p</i> &lt; 0.001). Postoperative complications occurred less frequently in the NIR group (6 vs. 16%, <i>p</i> = 0.200). The 3-year relapse-free survival rates were 80.5% in the NIR group and 80.1% in the non-NIR group (<i>p</i> = 0.934).</p> Conclusion <p>ICG-NIR fluorescence-guided laparoscopic colectomy enhances the precision of lymph node dissection and mesocolic excision, increases apical lymph node yield, and may improve surgical safety and efficiency. However, no survival advantage was observed.</p> Graphical abstract <p></p>

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Real-time indocyanine green fluorescence imaging enhances the precision of lymph node dissection in laparoscopic colon cancer surgery: a propensity score-matched cohort study

  • 期刊论文

  • 发表日期：

    2026年4月8日

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  • Yu Sato,
  • Masaaki Miyo,
  • Masayuki Ishii,
  • Ryo Miura,
  • Koichi Okuya,
  • Maho Toyota,
  • Hiroki Fujino,
  • Kohei Okamoto,
  • Ichiro Takemasa

摘要

Background

Complete mesocolic excision and D3 lymphadenectomy are essential for curative colon cancer surgery. However, identifying the optimal mesenteric dissection plane remains challenging. Near-infrared (NIR) fluorescence imaging using indocyanine green (ICG) enables real-time visualization of lymphatic flow, potentially enhancing surgical precision. This study aimed to evaluate the utility of ICG-NIR fluorescence guidance for precise lymph node dissection during laparoscopic colectomy for colon cancer.

Methods

Patients with stage II–III colon cancer who underwent laparoscopic colectomy with D3 lymphadenectomy, with (NIR group, n = 62) or without (non-NIR group, n = 65) ICG guidance, were retrospectively compared using propensity score matching. ICG (2.5 mg/mL) was injected submucosally near the tumor preoperatively. Fluorescent lymph nodes were identified and dissected intraoperatively. Outcomes included 3-year relapse-free survival, total and apical lymph node yields, blood loss, and postoperative complications.

Results

After propensity score matching, 50 patients were included in each group. The total lymph node yield tended to be higher in the NIR group (27.6 ± 11.3 vs. 23.4 ± 9.4; p = 0.052), whereas the number of apical lymph nodes harvested was significantly greater (6.8 ± 4.3 vs. 3.3 ± 2.5; p < 0.001). Operative time was comparable between groups (315 [178–934] vs. 291.5 [146–521] min; p = 0.236), whereas estimated blood loss was significantly lower in the NIR group (5 [5–220] vs. 60 [5–825] mL; p < 0.001). Postoperative complications occurred less frequently in the NIR group (6 vs. 16%, p = 0.200). The 3-year relapse-free survival rates were 80.5% in the NIR group and 80.1% in the non-NIR group (p = 0.934).

Conclusion

ICG-NIR fluorescence-guided laparoscopic colectomy enhances the precision of lymph node dissection and mesocolic excision, increases apical lymph node yield, and may improve surgical safety and efficiency. However, no survival advantage was observed.

Graphical abstract