Skip to main content

Advertisement

SpringerLink
Log in

Visualization of Lymph/Blood Flow in Laparoscopic Colorectal Cancer Surgery by ICG Fluorescence Imaging (Lap-IGFI)

  • Colorectal Cancer
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

In laparoscopic colorectal cancer (Lap-CRC) surgery, determination of a suitable mesentery division line and the appropriate degree of lymphadenectomy by tracing the blood supply is critical. We performed visualization of the lymph and blood flow by laparoscopic indocyanine green (ICG) fluorescence imaging (Lap-IGFI).

Methods

ICG is injected into the submucosa near the tumor via colonoscopy, and the lymph flow is observed. Intestinal blood flow is evaluated by administering ICG intravenously.

Results

For lymph flow, visualization of the main lymph node basin helped to determine the surgical division line for cases in which the blood flow was not completely visualized. Lap-IGFI changed the surgical plan of the lymphadenectomy in 23.5 %. In our experience, the metastatic rate of ICG-positive nodes was 10.0 %, and the metastatic rate of ICG-negative nodes was 5.3 %. Furthermore, there were no metastatic nodes that were ICG negative more than 5 cm from the tumor. For blood flow, the blood flow distribution of the intestinal wall from the last branch of the vasa recta of the anastomotic site was clearly visualized and proved useful in choosing the extent of intestinal resection. Lap-IGFI changed the surgical plan of the extensive intestinal resection in 16.7 %.

Conclusions

Lap-IGFI can noninvasively provide detailed lymph and blood flow information and is a useful device to aid in the accurate identification of individual patients’ lymph drainage. This helps dictate adequate lymphadenectomy and the extent of intestinal resection in Lap-CRC surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Siegel R, Ma J, Zou Z, Jemal A. Cancer statistics, 2014. CA Cancer J Clin. 2014;64:9–29.

    Article  PubMed  Google Scholar 

  2. Matsuda A, Matsuda T, Shibata A, et al. Cancer incidence and incidence rates in Japan in 2007: a study of 21 population-based cancer registries for the Monitoring of Cancer Incidence in Japan (MCIJ) project. Jpn J Clin Oncol. 2013;43:328–36.

    Article  PubMed  Google Scholar 

  3. Jamieson JK, Dobson JF. The lymphatics of the colon: with special reference to the operative treatment of cancer of the colon. Ann Surg. 1909;50:1077–90.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. West NP, Kobayashi H, Takahashi K, et al. Understanding optimal colonic cancer surgery: comparison of Japanese D3 resection and European complete mesocolic excision with central vascular ligation. J Clin Oncol. 2012;30:1763–9.

    Article  PubMed  Google Scholar 

  5. Okuno K. Surgical treatment for digestive cancer. Current issues—colon cancer. Dig Surg. 2007;24:108–14.

    Article  PubMed  Google Scholar 

  6. Tan KY, Kawamura YJ, Mizokami K, et al. Distribution of the first metastatic lymph node in colon cancer and its clinical significance. Colorectal Dis. 2010;12:44–7.

    Article  CAS  PubMed  Google Scholar 

  7. Japanese Society for Cancer of the Colon and Rectum. Japanese classification of colorectal carcinoma (2nd English ed.). Tokyo: Kanehara; 2009.

  8. Yuasa Y, Seike J, Yoshida T, et al. Sentinel lymph node biopsy using intraoperative indocyanine green fluorescence imaging navigated with preoperative CT lymphography for superficial esophageal cancer. Ann Surg Oncol. 2012;19:486–93.

    Article  PubMed  Google Scholar 

  9. Hirano A, Kamimura M, Ogura K, et al. A comparison of indocyanine green fluorescence imaging plus blue dye and blue dye alone for sentinel node navigation surgery in breast cancer patients. Ann Surg Oncol. 2012;19:4112–6.

    Article  PubMed  Google Scholar 

  10. Watanabe M, Tsunoda A, Narita K, et al. Colonic tattooing using fluorescence imaging with light-emitting diode-activated indocyanine green: a feasibility study. Surg Today. 2009;39:214–8.

    Article  PubMed  Google Scholar 

  11. Hirche C, Mohr Z, Kneif S, et al. Ultrastaging of colon cancer by sentinel node biopsy using fluorescence navigation with indocyanine green. Int J Colorectal Dis. 2012;27:319–24.

    Article  PubMed  Google Scholar 

  12. Noura S, Ohue M, Seki Y, et al. Feasibility of a lateral region sentinel node biopsy of lower rectal cancer guided by indocyanine green using a near-infrared camera system. Ann Surg Oncol. 2010;17:144–51.

    Article  PubMed  Google Scholar 

  13. Cahill RA, Anderson M, Wang LM, et al. Near-infrared (NIR) laparoscopy for intraoperative lymphatic road-mapping and sentinel node identification during definitive surgical resection of early-stage colorectal neoplasia. Surg Endosc. 2012;26:197–204.

    Article  PubMed  Google Scholar 

  14. Khan AA, Wheeler JM, Cunningham C, et al. The management and outcome of anastomotic leaks in colorectal surgery. Colorectal Dis. 2008;10:587–92.

    Article  CAS  PubMed  Google Scholar 

  15. van Westreenen HL, Ijpma FF, Wevers KP, et al. Reoperation after colorectal surgery is an independent predictor of the 1-year mortality rate. Dis Colon Rectum. 2011;54:1438–42.

    Article  PubMed  Google Scholar 

  16. Law WL, Choi HK, Lee YM, et al. Anastomotic leakage is associated with poor long-term outcome in patients after curative colorectal resection for malignancy. J Gastrointest Surg. 2007;11:8–15.

    Article  PubMed  Google Scholar 

  17. Allison AS, Bloor C, Faux W, et al. The angiographic anatomy of the small arteries and their collaterals in colorectal resections: some insights into anastomotic perfusion. Ann Surg. 2010;251:1092–7.

    Article  PubMed  Google Scholar 

  18. Ris F, Hompes R, Cunningham C, et al. Near-infrared (NIR) perfusion angiography in minimally invasive colorectal surgery. Surg Endosc. 2014;28:2221–6.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Jafari MD, Lee KH, Halabi WJ, et al. The use of indocyanine green fluorescence to assess anastomotic perfusion during robotic assisted laparoscopic rectal surgery. Surg Endosc. 2013;27:3003–8.

    Article  PubMed  Google Scholar 

  20. Yanagita S, Natsugoe S, Uenosono Y, et al. Detection of micrometastases in sentinel node navigation surgery for gastric cancer. Surg Oncol. 2008;17:203–10.

    Article  PubMed  Google Scholar 

  21. Reuthebuch O, Haussler A, Genoni M, et al. Novadaq SPY: intraoperative quality assessment in off-pump coronary artery bypass grafting. Chest. 2004;125:418–24.

    Article  PubMed  Google Scholar 

  22. Yamauchi K, Nagafuji H, Nakamura T, et al. Feasibility of ICG fluorescence-guided sentinel node biopsy in animal models using the HyperEye Medical System. Ann Surg Oncol. 2011;18:2042–7.

    Article  PubMed  Google Scholar 

  23. Rino Y, Yukawa N, Sato T, et al. Visualization of blood supply route to the reconstructed stomach by indocyanine green fluorescence imaging during esophagectomy. BMC Med Imaging. 2014;14:14–18.

    Article  Google Scholar 

  24. Takahashi H, Nara S, Ohigashi H, et al. Is preservation of the remnant stomach safe during distal pancreatectomy in patients who have undergone distal gastrectomy? World J Surg. 2013;37:430–6.

    Article  PubMed  Google Scholar 

  25. Kanemitsu Y, Komori K, Kimura K, et al. D3 lymph node dissection in right hemicolectomy with a no-touch isolation technique in patients with colon cancer. Dis Colon Rectum. 2013;56:815–24.

    Article  PubMed  Google Scholar 

  26. Cahill RA, Bembenek A, Sirop S, et al. Sentinel node biopsy for the individualization of surgical strategy for cure of early-stage colon cancer. Ann Surg Oncol. 2009;16:2170–80.

    Article  PubMed  Google Scholar 

  27. Park JS, Chang IT, Park SJ, et al. Comparison of ex vivo and in vivo injection of blue dye in sentinel lymph node mapping for colorectal cancer. World J Surg. 2009;33:539–46.

    Article  PubMed  Google Scholar 

  28. Joosten JJ, Strobbe LJ, Wauters CA, et al. Intraoperative lymphatic mapping and the sentinel node concept in colorectal carcinoma. Br J Surg. 1999;86:482–6.

    Article  CAS  PubMed  Google Scholar 

  29. Spasojevic M, Stimec BV, Dyrbekk AP, et al. Lymph node distribution in the D3 area of the right mesocolon: implications for an anatomically correct cancer resection. A postmortem study. Dis Colon Rectum. 2013;56:1381–7.

    Article  PubMed  Google Scholar 

  30. Taggart DP, Choudhary B, Anastasiadis K, et al. Preliminary experience with a novel intraoperative fluorescence imaging technique to evaluate the patency of bypass grafts in total arterial revascularization. Ann Thorac Surg. 2003;75:870–3.

    Article  PubMed  Google Scholar 

  31. Okamoto K, Muguruma N, Kimura T, et al. A novel diagnostic method for evaluation of vascular lesions in the digestive tract using infrared fluorescence endoscopy. Endoscopy. 2005;37:52–7.

    Article  CAS  PubMed  Google Scholar 

  32. Goligher JC. The adequacy of the marginal blood-supply to the left colon after high ligation of the inferior mesenteric artery during excision of the rectum. Br J Surg. 1954;41:351–3.

    Article  CAS  PubMed  Google Scholar 

  33. Hall NR, Finan PJ, Stephenson BM, et al. High tie of the inferior mesenteric artery in distal colorectal resections—a safe vascular procedure. Int J Colorectal Dis. 1995;10:29–32.

    Article  CAS  PubMed  Google Scholar 

Download references

Disclosure

The authors declare no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Surgery, Nara Medical University, Kashihara, Nara, Japan

    Naoto Nishigori MD, Fumikazu Koyama MD, Tadashi Nakagawa MD, Shinji Nakamura MD, Takeshi Ueda MD, Takashi Inoue MD, Keijirou Kawasaki MD, Shinsaku Obara MD, Takayuki Nakamoto MD & Yoshiyuki Nakajima MD

  2. Department of Endoscopy and Ultrasound, Nara Medical University, Kashihara, Nara, Japan

    Hisao Fujii MD

Authors
  1. Naoto Nishigori MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Fumikazu Koyama MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tadashi Nakagawa MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Shinji Nakamura MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Takeshi Ueda MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Takashi Inoue MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Keijirou Kawasaki MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Shinsaku Obara MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Takayuki Nakamoto MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Hisao Fujii MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Yoshiyuki Nakajima MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Naoto Nishigori MD.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nishigori, N., Koyama, F., Nakagawa, T. et al. Visualization of Lymph/Blood Flow in Laparoscopic Colorectal Cancer Surgery by ICG Fluorescence Imaging (Lap-IGFI). Ann Surg Oncol 23 (Suppl 2), 266–274 (2016). https://doi.org/10.1245/s10434-015-4509-0

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-015-4509-0

Keywords

Search

Navigation