Short-Term and Mid-Term Outcomes of Indocyanine Green Fluorescence Imaging Guided Laparoscopic Right-Sided Colectomy: A Propensity Score-Matched Cohort Study.

Abstract

With the use of indocyanine green fluorescence imaging, intraoperative lymphatic flow assessment is possible. However, there is no report which indicates mid-term outcomes of indocyanine green fluorescence imaging guided laparoscopic right-sided colectomy. The purpose of this study was to examine the mid-term outcomes of indocyanine green fluorescence imaging guided laparoscopic right-sided colectomy. This was a retrospective, multi-institutional study with propensity score matching. We conducted this study within the framework of the Yokohama Clinical Oncology Group in Japan. A total of 921 patients who underwent laparoscopic right-sided colectomy with lymph node dissection for colon cancer with clinical stage I to III between January 2009 and December 2020 were included. The patients were divided into two groups: 233 patients who underwent the lymphatic flow evaluation (indocyanine green group) and 688 patients who did not undergo lymphatic flow evaluation (non-indocyanine green group). The 3-year relapse-free survival after laparoscopic right-sided colectomy with and without indocyanine green fluorescence imaging were compared. After propensity score matching, 231 patients were matched in each group. The numbers of dissected central lymph nodes (6 vs 4, p < 0.001), and intermediate lymph nodes (7 vs 6, p = 0.03), and the total number of dissected lymph nodes (31 vs 27, p = 0.047) were significantly higher in the indocyanine green group. The median follow-up was 36.9 months. The estimated respective 3-year relapse-free survival and overall survival rates were 88.8% and 94.5% in the indocyanine green group and 89.4% and 94.7% in the non-indocyanine green group (p = 0.721 and 0.300), with no difference between the two groups. The limitations of this study include its retrospective design. Indocyanine green fluorescence imaging guided laparoscopic right-sided colectomy could increase the number of totals, intermediate and central lymph nodes. However, there was no difference in mid -term outcomes.