Role of Indocyanine Green Fluorescence Imaging in Laparoscopic Gastric Cancer Surgery

Abstract

Introduction: Adequate lymph node dissection and assessment of anastomotic perfusion are critical in gastric cancer surgery. Indocyanine green (ICG) fluorescence imaging has emerged as a real-time navigation tool. This review evaluates its utility in laparoscopic gastrectomy.

Methods: A systematic literature search was conducted in PubMed, Scopus, and Web of Science for peer-reviewed studies examining ICG-guided lymphadenectomy or perfusion assessment in gastric cancer. Inclusion criteria were clinical trials and cohort studies. Data were extracted for nodal harvest, anastomotic leak rates, and operative time.

Results: Fifteen studies met inclusion criteria. ICG guidance significantly increased the number of harvested lymph nodes compared to conventional surgery, particularly in stations around the gastroepiploic vessels. Anastomotic leak rates were reduced by approximately one-third in the ICG group, attributed to better intraoperative perfusion assessment. No significant difference in operative time was noted.

Discussion: The fluorescence signal enables visualization of lymphatic drainage patterns, allowing more complete nodal dissection without increasing morbidity. For perfusion, ICG helps identify hypoperfused bowel segments that might otherwise lead to leaks. Limitations include learning curve effects and cost of equipment. Heterogeneity in ICG dosing and timing requires standardization.

Conclusions: ICG fluorescence imaging improves lymph node yield and reduces anastomotic leaks in laparoscopic gastric cancer surgery. Further randomized trials are needed to confirm survival benefits.