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Long-term outcomes of indocyanine green fluorescence imaging-guided laparoscopic lateral pelvic lymph node dissection for clinical stage II/III middle-lower rectal cancer: a propensity score-matched cohort study

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Abstract

Background

We previously reported that indocyanine green fluorescence imaging (ICG-FI)-guided laparoscopic lateral pelvic lymph node dissection (LPLND) was able to increase the total number of harvested lateral pelvic lymph nodes without impairing functional preservation. However, the long-term outcomes of ICG-FI-guided laparoscopic LPLND have not been evaluated. The aim of the present study was to compare the long-term outcomes of ICG-FI-guided laparoscopic LPLND to conventional laparoscopic LPLND without ICG-FI.

Methods

This was a retrospective, multi-institutional study with propensity score matching. The study population included consecutive patients with middle-low rectal cancer (clinical stage II to III) who underwent laparoscopic LPLND between January 2013 and February 2018. The main evaluation items in this study were the 3-year overall survival, relapse-free survival (RFS), local recurrence rate, and lateral local recurrence (LLR) rate.

Results

A total of 172 patients with middle-lower rectal cancer who had undergone laparoscopic LPLND were included in this study. After propensity score matching, 58 patients were matched in each of the ICG-FI and non-ICG-FI groups. There were no substantial differences in the baseline characteristics between the two groups. The ICG-FI group and non-ICG-FI group included 40 and 38 women and had a median age of 65 (IQR 60–72) and 66 (IQR 60–73) years, respectively. The median follow-up for all patients was 63.7 (IQR 51.3–76.8) months. The estimated respective 3-year overall survival, RFS, and local recurrence rates were 93.1%, 70.7%, and 5.2% in the ICG-FI group and 85.9%, 71.7%, and 12.8% in the non-ICG-FI group (p = 0.201, 0.653, 0.391). The 3-year cumulative LLR rate was 0% in the ICG-FI group and 9.3% in the non-ICG-FI group (p = 0.048).

Conclusions

This study revealed that laparoscopic LPLND combined with ICG-FI was able to decrease the LLR rate. It appears that ICG-FI could contribute to improving the quality of laparoscopic LPLND and strengthening local control of the lateral pelvis.

Trials Registration

This study was registered with the Japanese Clinical Trials Registry as UMIN000041372 (http://www.umin.ac.jp/ctr/index.htm).

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Data Availability

The datasets generated during and/or analyzed during the current study are not available.

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Authors and Affiliations

  1. Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, 4-57, Urafune-Cho, Minami-Ku, Yokohama, 232-0024, Japan

    J. Watanabe, Y. Suwa, K. Goto & C. Kunisaki

  2. Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan

    J. Watanabe, H. Ohya, K. Nakagawa, M. Ozawa, A. Ishibe & I. Endo

  3. Department of Surgery, Yokosuka Kyosai Hospital, Yokosuka, Japan

    J. Sakai & H. Suwa

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  1. J. Watanabe
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  2. H. Ohya
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  3. J. Sakai
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Corresponding author

Correspondence to J. Watanabe.

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Conflict of interest

Dr. Jun Watanabe reports receiving honoraria for lectures from Johnson and Johnson, Medtronic and Eli Lilly, and receiving research funding from Medtronic, AMCO and TERUMO outside the submitted work. Drs. Hiroki Ohya, Jun Sakai, Yusuke Suwa, Kouki Goto, Kazuya Nakagawa, Mayumi Ozawa, Atsushi Ishibe, Hirokazu Suwa, Chikara Kunisaki, and Itaru Endo have no conflicts of interest or financial ties to disclose.

Ethical approval

This study protocol was approved by the Ethical Advisory Committee of Yokohama City University (B191200061) and the institutional review board of each participating hospital and conformed to the provisions of the Declaration of Helsinki.

Consent to participate

Due to the study’s retrospective nature, written informed consent was not obtained. Therefore, we used the opt-out approach to disclose the study information. Participants were provided with information about this project and were able to decline participation voluntarily.

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Watanabe, J., Ohya, H., Sakai, J. et al. Long-term outcomes of indocyanine green fluorescence imaging-guided laparoscopic lateral pelvic lymph node dissection for clinical stage II/III middle-lower rectal cancer: a propensity score-matched cohort study. Tech Coloproctol 27, 759–767 (2023). https://doi.org/10.1007/s10151-023-02761-x

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