Intraoperative fluorescence mapping of lymph nodes in colon cancer

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Objective. Evaluation of the effectiveness of different methods of introducing indocyanine green (ICG) for fluorescent mapping of lymph nodes during operations for colon cancer. Material and methods. The study included 32 patients with colon cancer, in whom fluorescent mapping of the ICG lymph nodes was used during surgical intervention to objectify the implementation of D3-lymphadenectomy. Results. When ICG was used, fluorescence of lymph nodes was determined in 28 (87.5%) patients. The duration of operations in these patients averaged 199.1±44.8 minutes. The average number of detected lymph nodes reached 25.4±10.6, of which 1.25±2.59 were metastatically affected. An increase in the volume of lymphadenectomy due to the use of ICG was performed in 3 (10.7%) cases. The number of fluorescent from the total number of detected lymph nodes was 77.1±12.7%. When comparing the results of submucosal and subserous ICG administration methods used in 10 and 22 patients, respectively, there were no statistically significant gender differences in the frequency of fluorescence of the lymph nodes, the number of fluorescent lymph nodes, and the duration of the surgical intervention. There were no complications associated with the use of ICG. Conclusion. The use of ICG in colon cancer surgery for fluorescent lymph nodes mapping is an informative, easily reproducible way for improving lymphadenectomy quality. Various methods of ICG administration near the tumor are comparable; intraoperative submucosal administration of ICG is associated with a longer operative time. The choice of the injection method can be carried out depending on tumor localization, endoscopic services availability, and surgeon preferences.

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