Clinical Effectiveness of Fluorescence Lymph Node Mapping Using ICG for Laparoscopic Right Hemicolectomy: A Prospective Case–Control Study

SIMPLE SUMMARY: Distinguishing D3 lymph nodes and actual lymphatic pathways from a primary tumor can be difficult during surgery, making it challenging to confirm the completeness of D3 lymph node dissection. Fluorescence lymph node mapping (FLNM) is a promising method for lymph node visualization. FLNM significantly increased the harvested D3 lymph node count by 50% and enhanced the detection rate of metastatic D3 lymph nodes by two times in stage III colon cancer. Consequently, FLNM can be effective in improving the oncological quality and completeness of D3 lymph node dissection in patients with stage III colon cancer during laparoscopic right hemicolectomy. ABSTRACT: Background: The distinction between D3 lymph nodes and actual lymphatic pathways in primary tumors can be difficult during surgery, making it challenging to confirm the completeness of D3 lymph node dissection. Fluorescence lymph node mapping (FLNM) is a promising method for lymph node visualization. Purpose: This study aimed to assess whether FLNM enhances the effectiveness of D3 lymph node dissection in patients with right-sided colon cancer. Methods: Endoscopic submucosal indocyanine green injection were performed on the distal margin of the colon cancer. In an FLNM group, the lymphatic drainage pathway and distribution of D3 lymph nodes were explored. Pathological evaluations were conducted for the fluorescent D3 and non-fluorescent D3 lymph nodes. Results: The FLNM group showed a significantly higher number of harvested lymph nodes in the D3 area. In stage III patients, the proportion of D3 lymph node metastasis was significantly higher in the FLNM group. The harvested D3 lymph node count showed a proportional correlation with a metastatic lymph node count of up to 15. Conclusion: FLNM could be considered a promising new strategy to potentially increase harvested D3 lymph node counts in colon cancer surgery.