Efficacy of ICG-guided bilateral lateral lymph node dissection in rectal cancer

Abstract

Objective

This study aims to assess the necessity and outcomes of bilateral lateral lymph node dissection (LLND) in rectal cancer, while exploring the role of Indocyanine Green (ICG) in enhancing surgical precision.

Methods

A retrospective analysis was conducted on 157 patients who underwent LLND between January 1, 2010, and December 31, 2022. The study focused on the incidence of bilateral lymph node metastasis, the predictors of metastasis, and the role of ICG-guided dissection in improving surgical outcomes. Propensity score matching (PSM) was used to compare the outcomes between the control and fluorescence-guided lymph node dissection (FLND) groups.

Results

Bilateral lateral lymph node metastasis was found in 6.4 ​% of patients. Positive D2 lymph nodes were the only significant predictor of bilateral metastasis. ICG, used via submucosal injection, significantly improved lymph node identification and dissection accuracy. Patients in the FLND group had a higher median number of harvested lymph nodes (32 vs. 19, P ​= ​0.042) and better postoperative outcomes, including shorter hospital stay (6 vs. 9 days, P ​= ​0.038) and less blood loss (30 ​ml vs. 180 ​ml, P ​< ​0.001). Kaplan-Meier analysis showed no significant differences in disease-free survival (P ​= ​0.658) or overall survival (P ​= ​0.331) between groups.

Conclusion

While ICG-enhanced bilateral LLND improves short-term surgical outcomes, its impact on long-term survival remains unclear. The findings suggest selective use of bilateral LLND based on specific risk factors, particularly in patients with positive D2 lymph nodes. Further studies are required to refine guidelines and establish the procedure's long-term benefits.