Efficacy of Nano-Carbon Tracing Versus Indocyanine Green in Lymph Node Detection for Minimally Invasive Colorectal Resection

BACKGROUND Endoscopy-assisted nano-carbon tracing can improve lymph node detection and dissection in colorectal cancer surgery and enhance staging accuracy. This prospective comparative study evaluated the efficacy of endoscopy-assisted nano-carbon tracing versus indocyanine green guidance in lymph node retrieval and clinical outcomes among patients undergoing minimally invasive colorectal resection. MATERIAL AND METHODS Between June 2022 and May 2024, 200 adults with colorectal cancer were enrolled and assigned to nano-carbon (n=100) or indocyanine green (n=100) groups according to surgeon preference. Both tracers were injected submucosally in 4 quadrants under endoscopic guidance, 10 to 30 min before surgery. Primary outcomes included number of lymph nodes retrieved and labeling success rate. Secondary outcomes were 30-day postoperative complications, disease-free survival (DFS), overall survival (OS), and quality of life (QoL) assessed via EORTC QLQ-C30 questionnaire. RESULTS The nano-carbon group had more lymph nodes retrieved (18.75±4.21 vs 17.10±5.03; P=0.045) and higher labeling success (76.35%±9.87% vs 48.10%±10.25%; P<0.001). At 24 months, DFS and OS were superior in the nano-carbon group (76.0% and 85.5% vs 65.0% and 76.2%; log-rank P=0.023 and 0.037). Infection (6% vs 10%, P=0.045) and deep vein thrombosis (4% vs 7%, P=0.031) were reduced in that group; QoL scores were higher at 6 and 12 months (P<0.05). CONCLUSIONS Endoscopy-assisted nano-carbon tracing improved lymph node yield, reduced complications, and enhanced survival and QoL, indicating safety and efficacy in minimally invasive colorectal cancer surgery.