The value of indocyanine green imaging technique in radical resection of rectal cancer with left colonic artery preserved

doi:10.3877/cma.j.issn.1674-3946.2025.02.006.

Abstract

Abstract:

Objective

To investigate the application value of indocyanine green (ICG) imaging technique in the preservation of left colic artery (LCA) during laparoscopic radical resection of rectal cancer.

Method

The data of 80 patients with LCA who underwent laparoscopic radical resection for rectal cancer from April 2022 to January 2024 were retrospectively analyzed and divided into ICG group (n=40 cases) and control group (n=40 cases) according to different operation methods.The ICG group was assisted by indocyanine green development to preserve LCA, while the control group underwent conventional laparoscopic radical resection of rectal cancer to preserve LCA.SPSS26.0 software was used to analyze the data.The perioperative period and other measurement data of the two groups were expressed as (± s), and independent sample t test was used.Postoperative complications and left colic artery retention rate were measured by χ² test.P＜0.05 was considered statistically significant.

Results

The intraoperative blood loss, postoperative bowel sound recovery time and hospital stay in ICG group were lower than those in control group, and the success rate of LCA retention, total lymph nodes and the number of lymph nodes dissection in group 253 were higher than those in control group,with statistical significance (P＜0.05).There were no significant differences in operation time, lymph node metastasis rate and postoperative complication rate between 2 groups (P＞0.05).

Conclusion

Indocyanine green imaging technology can improve the success rate of LCA retention, increase the lymph node clearance rate, reduce the amount of intraoperative blood loss, and has the value of popularization.

Key words: Rectal Tumor, Rectal Cancer Radical Surgery, Laparoscopes, Indocyanine Green, Left Colon Artery, Lymph Node Dissection

Jian Xiao, Tianbao Xiao, Jiang Chen, Tao Yang, Feng He, Tiantian Bao, Yibo Cao, Qin Yang, Ying Zhao. The value of indocyanine green imaging technique in radical resection of rectal cancer with left colonic artery preserved[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2025, 19(02): 134-137.

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Figures/Tables 7

组别	例数	性别（例）	年龄（岁， $\bar{x}$ ±s）	体重指数（kg/m²， $\bar{x}$ ±s）	肿瘤位置（例）	肿瘤直径（cm， $\bar{x}$ ±s）
组别	例数	（男/女）	年龄（岁， $\bar{x}$ ±s）	体重指数（kg/m²， $\bar{x}$ ±s）	上段/中段/下段	肿瘤直径（cm， $\bar{x}$ ±s）
ICG组	40	24/16	55.9±11.6	25.8±3.0	23/12/5	4.5±0.8
对照组	40	27/13	59.7±12.7	24.6±3.3	20/17/3	4.8±0.7
χ ²/t值		0.487	1.416	1.751	1.571	1.601
P值		0.485	0.161	0.084	0.456	0.113

组别	例数	性别（例）	年龄（岁， $\bar{x}$ ±s）	体重指数（kg/m²， $\bar{x}$ ±s）	肿瘤位置（例）	肿瘤直径（cm， $\bar{x}$ ±s）
组别	例数	（男/女）	年龄（岁， $\bar{x}$ ±s）	体重指数（kg/m²， $\bar{x}$ ±s）	上段/中段/下段	肿瘤直径（cm， $\bar{x}$ ±s）
ICG组	40	24/16	55.9±11.6	25.8±3.0	23/12/5	4.5±0.8
对照组	40	27/13	59.7±12.7	24.6±3.3	20/17/3	4.8±0.7
χ ²/t值		0.487	1.416	1.751	1.571	1.601
P值		0.485	0.161	0.084	0.456	0.113

组别	例数	手术时间（min， $\overset{ˉ}{x}$ ±s）	术中出血量（ml， $\overset{ˉ}{x}$ ±s）	LCA保留成功率［例(%)］
ICG组	40	135.4±8.3	53.9±8.6	40（100.0）
对照组	40	133.8±6.7	75.2±8.2	34（85.0）
χ ²/t值		0.964	11.358	-
P值		0.338	0.000	0.026

组别	例数	手术时间（min， $\overset{ˉ}{x}$ ±s）	术中出血量（ml， $\overset{ˉ}{x}$ ±s）	LCA保留成功率［例(%)］
ICG组	40	135.4±8.3	53.9±8.6	40（100.0）
对照组	40	133.8±6.7	75.2±8.2	34（85.0）
χ ²/t值		0.964	11.358	-
P值		0.338	0.000	0.026

组别	例数	肠鸣音恢复时间（h， $\overset{ˉ}{x}$ ±s）	住院时间（d， $\overset{ˉ}{x}$ ±s）	肿瘤TNM分期（例）	253组淋巴结转移率［例(%)］
组别	例数	肠鸣音恢复时间（h， $\overset{ˉ}{x}$ ±s）	住院时间（d， $\overset{ˉ}{x}$ ±s）	Ⅰ/Ⅱ/Ⅲ	253组淋巴结转移率［例(%)］
ICG组	40	50.3±4.1	12.3±2.1	22/11/7	1(2.5)
对照组	40	52.8±4.9	13.4±2.7	25/9/6	3(7.5)
χ ²/t值		2.476	2.011	0.468	0.263
P值		0.015	0.048	0.791	0.608

组别	例数	肠鸣音恢复时间（h， $\overset{ˉ}{x}$ ±s）	住院时间（d， $\overset{ˉ}{x}$ ±s）	肿瘤TNM分期（例）	253组淋巴结转移率［例(%)］
组别	例数	肠鸣音恢复时间（h， $\overset{ˉ}{x}$ ±s）	住院时间（d， $\overset{ˉ}{x}$ ±s）	Ⅰ/Ⅱ/Ⅲ	253组淋巴结转移率［例(%)］
ICG组	40	50.3±4.1	12.3±2.1	22/11/7	1(2.5)
对照组	40	52.8±4.9	13.4±2.7	25/9/6	3(7.5)
χ ²/t值		2.476	2.011	0.468	0.263
P值		0.015	0.048	0.791	0.608

组别	例数	吻合口漏	肠梗阻	切口感染	预防性造瘘
ICG组	40	0（0.0）	1（2.5）	0（0.0）	4（10.0）
对照组	40	2（5.0）	3（7.5）	1（2.5）	6（15.0）
χ ²值		-	0.263	-	0.114
P值		0.494	0.608	1.000	0.735

References 21

［1］	范新宇, 方锡才, 崔巍.保留左动脉与高位结扎用于腹腔镜直肠癌根治术的近中期随访比较［J/CD］.中华普外科手术学杂志(电子版), 2022(01): 44-47.
［2］	琚然, 刘平, 缪琦.腹腔镜直肠癌前切除术保留左结肠动脉对患者肠胃功能及术后并发症的影响［J］.河北医学, 2024,30(01): 76-80.
［3］	Huang Z, Liao J, Lai H, et al.Oncology Outcomes of Total Mesorectal Excision with Preservation of Both the Superior Rectum Artery and Left Colonic Artery for Upper-Rectal and Sigmoid Colon Cancers: A Meta-Analysis ［J］.J Laparoendosc Adv Surg Tech A, 2022, 32(5): 495-505.
［4］	Wang X, Li J, Chen W, et al.Preserving the left colonic artery in radical sigmoid and rectal cancer surgery is feasible: A metaanalysis［J］.Medicine (Baltimore), 2024, 103(4): e37026.
［5］	潘勇成, 杜欣宇, 杜欣蕾, 等.腹腔镜直肠癌前切除术中保留左结肠动脉3年随访比较［J/CD］.中华普外科手术学杂志(电子版), 2021, 15(06): 643-646.
［6］	Brillantino A, Skokowski J, Ciarleglio FA, et al.Inferior Mesenteric Artery Ligation Level in Rectal Cancer Surgery beyond Conventions: A Review［ J］.Cancers (Basel), 2023, 16(1): 72.
［7］	沈海玉, 刘正, 梅世文, 等.基于CT血管造影和血管三维重建技术的肠系膜下动脉及分支临床解剖学研究［J］.中华结直肠疾病电子杂志, 2021, 10(03): 284-290.
［8］	袁瑜, 郭敏, 廖凯, 等.基于CTA的血管3D可视化技术在保留左结肠动脉的腹腔镜直肠癌根治术患者中的应用效果［J］.医疗装备, 2022, 35(24): 65-69.
［9］	陈永军, 陈文瑾, 赵波, 等.吲哚菁绿荧光导向在直肠癌外科手术中的应用研究［J］.广西医科大学学报, 2023, 40(08):1427-1432.
［10］	中华人民共和国国家卫生健康委员会医政医管局, 中华医学会肿瘤学分会.中国结直肠癌诊疗规范（2020年版）［J］.中国实用外科杂志, 2020, 40(06): 601-625.
［11］	Murono K, Kawai K, Kazama S, et al.Anatomy of the inferior mesenteric artery evaluated using 3-dimensional CT angiography［J］.Dis Colon Rectum.2015, 58(2): 214-219.
［12］	《保留左结肠动脉的直肠癌根治术中国专家共识》编审委员会, 中国医师协会肛肠医师分会大肠癌综合治疗组, 中西医结合学会普通外科专业委员会直肠癌防治专家委员会.保留左结肠动脉的直肠癌根治术中国专家共识(2021版［)J］.中华胃肠外科杂志, 2021, 24(11): 950-955.
［13］	Chiarello MM, Fransvea P, Cariati M, et al.Anastomotic leakage in colorectal cancer surgery［ J］.Surg Oncol, 2022, 40: 101708.
［14］	孙跃明, 唐俊伟.腹腔镜直肠癌根治术保留左结肠动脉关键技术与意义［J/CD］.中华普外科手术学杂志(电子版),2019(01): 13-15.
［15］	李博, 胡刚, 邱文龙, 等.原始荧光模式下吲哚菁绿荧光血管造影技术辅助直肠癌根治术中保留左结肠动脉可行性研究［J］.中国实用外科杂志, 2023, 43(05): 578-582.
［16］	张中华, 刘扬, 毛伟明, 等.ICG显影技术辅助吻合口血运判断在保留左结肠动脉的腹腔镜直肠癌根治术中临床意义研究［J/CD］.中华普外科手术学杂志（电子版）, 2022, 16(06):688-691.
［17］	Hu S, Li S, Teng D, et al.Analysis of risk factors and prognosis of 253 lymph node metastasis in colorectal cancer patients［J］.BMC Surg, 2021, 21(1): 280.
［18］	Ryu S, Suwa K, Kitagawa T, et al.Real-Time Fluorescence Vessel Navigation Using Indocyanine Green During Laparoscopic Colorectal Cancer Surgery［J］.Anticancer Res, 2019, 39(6): 3009-3013.
［19］	Lucas K, Melling N, Giannou AD, et al.Lymphatic mapping in colon cancer depending on injection time and tracing agent: a systematic review and meta-analysis of prospective designed studies［ J］.Cancers (Basel), 2023, 15(12): 3196.
［20］	张建锋, 高相鑫, 武雪亮, 等.吲哚菁绿荧光导航结直肠癌253组淋巴结清扫的安全性、可行性及临床价值［J］.实用医学杂志, 2021, 37(12): 1598-1602.
［21］	Wan J, Wang S, Yan B, et al.Indocyanine green for radical lymph node dissection in patients with sigmoid and rectal cancer:randomized clinical tria［lJ］.British journal of surgery open, 2022,6(6): 151.

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