Interests of Fluorescence in Colorectal Surgery
Seance of wednesday 05 march 2025 (Journée cancérologie : Cancer colorectal)
DOI number : 10.26299/41b7-dq90/2025.09.08
Abstract
In 1853, GA Stokes defined fluorescence as the light emission caused by a molecule after absorbing a photon. This principle allows surgical endoscopes to visualize vessels or lymphatics after the injection of indocyanine green (ICG).
After intravenous injection, the vascularization of the anastomosis can be controlled. The intensity of the green diffusion indicates its quality. Two large randomized trials (Essential trial and AVOID) have shown a significant reduction in the rate of anastomotic fistula for colorectal anastomoses.
When injected submucosally, ICG fixation occurs in the lymphatic system. We conducted a feasibility study of mesorectal lymph node dissection for aggressive T1 tumors, for which the standard is TME.
The initial results show an average number of 16 lymph nodes removed; one patient pN+, 2 days of hospitalization; no morbidity; no progression at 20 months follow-up.
This technique will need to be validated by a prospective multicenter study.
After intravenous injection, the vascularization of the anastomosis can be controlled. The intensity of the green diffusion indicates its quality. Two large randomized trials (Essential trial and AVOID) have shown a significant reduction in the rate of anastomotic fistula for colorectal anastomoses.
When injected submucosally, ICG fixation occurs in the lymphatic system. We conducted a feasibility study of mesorectal lymph node dissection for aggressive T1 tumors, for which the standard is TME.
The initial results show an average number of 16 lymph nodes removed; one patient pN+, 2 days of hospitalization; no morbidity; no progression at 20 months follow-up.
This technique will need to be validated by a prospective multicenter study.