Narrative Review on the Use of Indocyanine Green Fluorescence in Surgical Oncology.

Abstract

Indocyanine green (ICG) has emerged as a transformative tool for intraoperative imaging in the field of oncology, significantly improving the identification and localization of tumors, lymphatic structures and metastatic lesions. This narrative review aims to synthesize findings from a comprehensive range of studies that evaluate the efficacy, applications and limitations of ICG fluorescence-guided surgery across various surgical specialties, including colorectal, gynecologic and hepatobiliary oncology. We meticulously analyzed studies published from 2010 to the present, highlighting the technical aspects of ICG administration and imaging techniques as well as the quantitative metrics of success, such as detection rates and negative surgical margins. The review identifies a trend toward increasing use of ICG due to its ability to provide real-time feedback during surgery, thus facilitating more precise and minimally invasive procedures. Moreover, this review explores recent advancements in ICG applications, including multimodal imaging techniques that combine fluorescence with other imaging modalities, such as near-infrared imaging and preoperative imaging studies. These innovations hold promise for further enhancing surgical precision, improving patient outcomes and optimizing intraoperative decision-making. Limitations associated with ICG use, such as variability in fluorescence intensity among different tumor types and the challenge of quantifying the optimal dosage, are also discussed. In conclusion, this narrative review underscores the critical role of ICG fluorescence in modern surgical oncology and provides insights into future research directions aimed at refining its use and expanding its applicability. Potential avenues for investigation include standardized protocols for ICG administration, investigation of patient selection criteria and comprehensive evaluations of long-term outcomes associated with ICG-guided surgical procedures.