Real-time fluorescence image-guided gastrointestinal oncologic surgery: Towards a new era

Table 1 Summary of the outcomes of indocyanine green-fluorescence angiography to prevent anastomotic leakage after colorectal and esophageal resections

Ref.	Study design	Total n	ICG group	Non-ICG group	Anastomosis leak n (%)	P value	Surgical plan change (%)
Colorectal
Kudszus et al[22], 2010	Retrospective-matched	402	201	201	ICG: 7 (3.5%); NICG: 15 (7.5%)	0.04	16%
Jafari et al[23], 2013	Case-control	38	16	22	ICG: 1 (6%); NICG: 4 (18%)	NS	19% cases4.5% controls
Kim et al[55], 2015	Case-control	436	123	313	ICG: 1 (0.8%); NICG: 17 (5.4%)	NS	Not reported
De Nardi et al[25], 2020	Randomized controlled trial	240	118	122	ICG: 6 (5%); NICG: 11 (9%)	NS	11%
Alekseev et al[26], 2020	Randomized controlled trial	377	187	190	ICG: 17 (9.1%); NICG: 31 (16.3%)	0.04	Not reported
Arezzo et al[27], 2020	Meta-analysis	1330	862	468	ICG: 36 (4.2%); NICG: 53 (11.3%)	< 0.001	11.3%
Esophageal
Zehetner et al[43], 2015	Prospective	150	150	N/A	4.6%	N/A	66%
Kumagai et al[47], 2018	Cohort series	70	70	N/A	1.4%	N/A	50%
Ladak et al[45], 2019	Meta-analysis	1067	631	436	Overall: 10.8%; ICG: 5.7%; NICG: 22.9%	NR	Not reported
Slooter et al[48], 2020	Cohort series	84	84	N/A	14.3%	N/A	2.4%

ICG: Indocyanine green; N/A: Not applicable; NICG: Non-indocyanine green; NR: Not reported; NS: Not significative.

Table 2 Summary of the studies on involving lymph node detection in gastrointestinal cancer

Ref.	Patients	Detection rate	Sensitivity	Specificity	Considerations
Kusano et al[76], 2008	26 CRC, 22 GC	CRC: 90.9%, GC: 88%	CRC: S: 25%1, GS: 40%1	Sp: 100%1, Sp: 100%1	CRC: PPV: 100% NPV: 81%, GC: PPV: 100% NPV: 62.5%
Cahill et al[78], 2009	891	NR	81%	93.2%1	PPV: 62% NPV: 95%. Lower FN if tumor size is less than 35 mm. IHC analysis increases sensitivity
Noura et al[58], 2010	25	92%	100%	100%	FNR: 0%. NPV: 100% Performed lateral pelvic dissection in order to increase SN detection accuracy
Kitagawa et al[80], 2013	397	97.5%	93.44%1	98.99%1	Uses dual technique (blue dye and ICG)
Kinami et al[82], 2015	72		90%	98%1	FN: 1.3%
Tummers et al[79], 2016	26	95%	75%	88.9%	Reduces second-tier nodes using nanocolloids
Lee et al[83], 2016	20	95%	100%	94.4%	FN: 0%
Villegas-Tovar et al[57], 2020	281	91%	64.3%	65%	AUC: 66.5%

¹Calculated using the data provided at the papers. AUC: Area under the curve; CRC: Colorectal cancer; FN: False negatives; FNR: False negative rate; GC: Gastric cancer; ICH: Immunohistochemistry; NPV: Negative predictive value; NR: Non reported; PPV: Positive predictive value; SN: Sentinel node.

Table 3 Summary of the studies evaluating the role of indocyanine green to detect peritoneal carcinomatosis

Ref.	Yr	Patients	Nodules	Additional nodules	Sensitivity	Specificity	Considerations
Liberale et al[95], 2020	2016	14	63	21.4%	87.5%	100%
Barabino et al[96], 2020	2016	10	88		72.4%	77.3%
Filippello et al[97], 2020	2016	10	29		65%	57.1%	Same patients than Barabino et al[96], but comparing the use of bevacizumab or not
Lieto et al[100], 2020	2018	4	69	16	96.9%	75%	ICG adds 25% of diagnostic improvement
Sluiter et al[104], 2020	2019	28	169		80%	74.8%	NBI increases sensitivity from 80% to 96% when compared with white light, with the same specificity

ICG: Indocyanine green; NBI: Narrow band imaging.