Indocyanine green and near-infrared fluorescence imaging in minimally invasive gastric cancer surgery: a narrative review

Abstract

Background: The popularity of minimally invasive surgery for gastric cancer has been on the rise due to its advantages in faster recovery and improved outcomes. However, the lack of tactile sensation poses challenges for tumor identification and anatomical recognition. Indocyanine green (ICG) with near-infrared (NIR) fluorescence imaging has emerged as a potential solution to address these challenges. This review summarizes the current status, limitations, and future prospects of ICG and NIR fluorescence imaging in minimally invasive surgery for gastric cancer. Search strategy: This narrative review searched the PubMed database for relevant articles related to ICG and NIR fluorescence imaging in minimally invasive gastric cancer surgery, published through 2023. The search criteria comprised “indocyanine green”, “ICG”, “near-infrared fluorescence imaging”, “gastric cancer”, “gastrectomy”, and “minimally invasive surgery”. Findings: ICG with NIR fluorescence imaging offers three main applications in gastric cancer surgery. Firstly, it aids in real-time intraoperative tumor identification when injected locally around the tumor, surpassing traditional tattooing techniques. Secondly, ICG facilitates lymph node mapping, particularly in identifying sentinel lymph nodes, which could reduce unnecessary lymphadenectomy. Thirdly, ICG angiography enables the assessment of blood perfusion during reconstructive surgery, evaluating anastomosis sites and potentially reducing anastomotic leakage risk. Conclusions: ICG and NIR fluorescence imaging have shown promising advancements in enhancing the precision and safety of minimally invasive gastric cancer surgery. However, standardized analysis methods and further prospective studies are needed to fully establish their clinical significance. Overall, ICG and NIR fluorescence imaging hold potential as valuable tools to improve patient outcomes in minimally invasive gastric cancer surgery.