Augmented reality with intraoperative indocyanine green lymphatic mapping in colorectal cancer: personalized surgery or a glowing distraction? A scoping review.

Abstract

Introduction: Colorectal cancer (CRC) is a leading cause of cancer-related death globally, where precise lymph node (LN) assessment remains critical for accurate staging and prognosis. Indocyanine green fluorescence imaging (ICG-FI) has emerged as a potential tool to enhance intraoperative lymphatic visualization and guide tailored lymphadenectomy.

Aim: This scoping review evaluated the current evidence on ICG-FI lymphatic mapping in CRC surgery, focusing on its impact on surgical outcomes and identifying research gaps.

Materials and methods: A comprehensive literature search of the MEDLINE database (2005-2025) was performed using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines. The included studies investigated ICG-FI lymphatic mapping in adult CRC patients. A qualitative synthesis was conducted across the following thematic domains: mesenteric mapping, sentinel LN (SLN) assessment, and lateral pelvic LN dissection (LPLND).

Result: Of the 67 records identified, 34 studies met the inclusion criteria. Several studies demonstrated ICG-FI safety and feasibility, with high lymphatic flow visualization rates (75.4%-100%) and improved LN yield. Aberrant LN detection occurred in up to 50% of the cases, although these were rarely metastatic. SLN mapping showed high detection rates but variable sensitivity (63%-75%) and frequent false negatives. LPLND guided by ICG-FI showed a potential in reducing lateral recurrence, but not in improving overall survival.

Conclusion: ICG-FI enhances anatomical precision during CRC surgery and facilitates individualized lymphadenectomy. However, its oncologic benefit remains unproven. Standardization of protocols and further prospective studies are required to validate its clinical utility and long-term impact on patient outcomes.