Role of fluorescence navigation with indocyanine green during lateral pelvic lymphodissection in the treatment of rectal cancer (meta-analysis)

INTRODUCTION: intraoperative fluorescence navigation with indocyanine green (ICG) allows visualizing possible affected lymph nodes, which hypothetically provides more precise lateral pelvic node dissection (LPND). AIM: to compare immediate results of lateral pelvic node dissection (LPND) combined with fluorescence navigation with ICG and conventional LPND for the treatment of metastatic lesions of lateral pelvic lymph nodes in patients with rectal cancer. PATIENTS AND METHODS: search was performed in the PubMed library (National Library of Medicine, Bethesda, MD, USA) with keywords “indocyanine green,” “ICG“, ”lymph nodes,” “lateral lymph node dissection,” and “rectal cancer” in various combinations. Four non-randomized studies were included in meta-analysis, three retrospective and one prospective, on the outcomes of ICG use during LPND in patients with rectal cancer in the meta-analysis. RESULTS: significantly more lymph nodes were harvested in LPND + ICG group (MD = 4.5; 95% CI: 3.0–5.9; p < 0.00001). The operation time was longer in the ICG group (MD = 32.5; 95% CI: 2.8–62.3; p = 0.03). Intraoperative blood loss was higher in conventional LPND group (MD = −52.6; 95% CI: −89.8 — −15.3; p = 0.006). Hospital stay was significantly shorter in ICG group (MD = −1.2; 95% CI: −2.0 — −0.4; p = 0.003). Patients who underwent standard LPND were significantly more likely to have postoperative urinary retention (OR = 0.4; 95% CI: 0.1–0.9; p = 0.03). CONCLUSION: fluorescence navigation with ICG improves early results of LPND. Further accumulation of experience with dynamic follow-up of patients is crucial.