The optimal extent of lymph node dissection in colon cancer surgery is specified in guidelines based on the results of past analyses. However, with advances in surgical techniques and multidisciplinary treatments, the clinical significance of dissecting each lymph node may change. In this study, we re-examined the optimal dissection range in each colon cancer localization. We retrospectively analyzed 788 cases of T1-T4 colon cancer who underwent radical resection between 2008 and 2018 at our hospital, and evaluated the Lymphadenectomy Index. No metastases to the main lymph node were found in T1 cases. In T2 cases, dissection effect to the main lymph node were observed in cases with tumors localized in the ascending colon and left side of the transverse colon. For tumors localized in the cecum, dissection was effective for lymph nodes in nodal station 213, in the right side of the transverse colon in station 211, in the descending colon in station 221, and in the sigmoid colon in station 231. These lymph nodes could have been considered out of scope for dissection if the Japanese guidelines were followed. In these cases, the extent of lymph node dissection should be carefully considered on a case-by-case basis.

Lateral pelvic lymph node dissection (LPLND) provides oncologic benefits in patients with rectal cancer who have enlarged lateral nodes. However, anatomical complexity in the lateral pelvis makes the procedure technically challenging,  which may lead to  increased intraoperative blood loss, prolonged operative time, postoperative complications and incomplete lymph node dissection. To address such technical  challenges, various surgical navigation tools have been developed. In this up-to-date narrative review, we summarize the current evidence on surgical navigation for LPLND and discuss their advantages,  limitations and future perspectives.

Lateral pelvic lymph node (LPLN) metastasis is one of the prominent reasons for local recurrence in patients with rectal neuroendocrine tumors (RNETs). The evaluation criteria of lateral lymph node metastasis for patients and the indications and value of lateral pelvic lymph node dissection (LPLD) have been controversial. Total mesorectal excision (TME), a conventional surgical treatment for RNETs, excluding lateral lymph nodes, may be one of the reasons for postoperative local recurrence. This study aimed to analyze the risk factors for LPLN metastasis in patients with RNETs in order to guide surgical methods.

We searched relevant databases (PubMed, Embase, Medline, Cochrane Library, and Web of Science) for articles published between 1 January 2000 and 1 April 2024 to evaluate the risk factors for LPLN metastasis in patients with RNETs in this meta-analysis.

A total of seven articles with 433 patients were included in this study. The overall results showed that a WHO grade > G1, tumor invasion of the muscularis propria or deeper, lymphovascular invasion (LVI), mesorectal lymph node metastasis (MLNM), and distant metastasis (M1) were significant risk factors for LPLN metastasis in patients with RNETs (P <0.05).

This study identified key risk factors for LPLN metastasis in patients with RNETs, providing guidance for treatment strategies. A comprehensive evaluation of these risk factors and imaging findings is recommended to tailor personalized treatment strategies that optimize survival outcomes and improve quality of life.

https://www.crd.york.ac.uk/prospero/, identifier CRD42024581891.

We have evaluated lateral pelvic lymph node dissection (LPLND) in combination with rectal resection in the treatment of locally advanced rectal cancer in a specialized colorectal surgical department with a focus on safety and feasibility.

The study analyzed surgical-pathologic outcomes in 17 consecutive patients who underwent robotic LPLND and rectal resection between May 2018 and June 2024 at a high-volume colorectal cancer center in Denmark. Patients were selected for the procedure based on lateral lymph node (LLN) diameter ≥ 8 mm before and ≥ 5 mm after neoadjuvant treatment.

Out of 17 patients (15 men and 2 females) included in this study, 13 patients (76%) had undergone neoadjuvant therapy. The median age was 63 years (range 35-79) with a median BMI of 25.6 kg/m2 (range 19.4-34.5). The total median operation time was 335 min (range 182-526 min) with no conversions necessary. Additional resection of structures beyond the total mesorectal excision plane was performed in eight patients (47%). The median hospital stay was 4 days (range 2-14) and one patient was readmitted within 30 days. Seven patients experienced postoperative complications within 30 days, with only one CD complication ≥ grade 3. The median number of resected LLNs was 4 (range 0-11) per patient and malignant LLNs were verified in three patients (17.6%).

This study shows that simultaneous robot-assisted LPLND and rectal resection can be performed safely and effectively in selected patients with locally advanced rectal cancer, with a short hospital stay and few readmissions and postoperative complications.

This study is aimed to explore the safety and feasibility of indocyanine green (ICG) fluorescence imaging guidance in laparoscopic para-aortic lymph node (PALN) dissection for left-sided colorectal cancer (CRC) patients with clinically suspected PALN metastasis.

A total of 151 patients who underwent primary tumor resection and laparoscopic PALN dissection for left-sided CRC were included, with 20 patients in the ICG group and 131 patients in the non-ICG group. The surgical outcomes, postoperative complications, and pathological results, such as the number of harvested and metastatic lymph nodes were compared between groups after propensity score matching.

Following propensity score matching, the ICG group had 20 patients, and the non-ICG group had 53 patients, and the two groups were similar in baseline characteristics. No significant differences were observed in overall intraoperative and postoperative complications between groups, except for chylous leakage, where the ICG group had a longer time to a normal diet. The number of harvested pericolic/perirectal and intermediate lymph nodes were comparable between the two groups, while the ICG group had a significantly higher number of total harvested lymph nodes (39 [14-78] vs. 29 [11-70], P = 0.001), inferior mesenteric artery lymph nodes (IMALN, 6 [0-17] vs. 3 [0-11], P = 0.006), and PALNs (9 [3-29] vs. 5 [1-37], P = 0.001).

ICG fluorescence imaging could increase the retrieval of IMALN, PALN, and total lymph nodes, and potentially improve the completeness of laparoscopic PALN dissection in patients with left-sided CRC.

Lateral lymph node dissection (LLND) for rectal cancer is still not a widely established technique owing to the existing controversy between Eastern and Western countries and the lack of well-designed studies. The risk of complications and the paucity of long-term oncological results are significant drawbacks for further applying this technique. The use of indocyanine green (ICG) near-infrared (NIR) fluorescence for LLND appears as a promising technique for enhancing postoperative and oncological outcomes. This review aims to evaluate the emerging role of ICG during LLND and present the benefits of its application.

Systematic electronic research was conducted in PubMed and Google Scholar using a combination of medical subject headings (MeSH). Studies presenting the use of ICG during LLND, especially in terms of harvested lymph nodes, were included and reviewed. Studies comparing LLND with ICG (LLND + ICG) or without ICG (LLND-alone) were further analyzed for the number of lymph nodes and postoperative outcomes.

In total, 13 studies were found eligible and analyzed for different parameters. LLND + ICG is associated with significantly increased number of harvested lateral lymph nodes (p < 0.05), minor blood loss, decreased operative time, and probably decreased urinary retention postoperatively compared with LLND-alone.

The use of ICG fluorescence during LLND is a safe and feasible technique for balancing postoperative outcomes and the number of harvested lymph nodes. Well-designed studies with long-term results are required to elucidate the oncological benefits and establish this promising technique.

In recent years, the rise of minimally invasive surgery has driven the development of surgical devices. Indocyanine green (ICG) fluorescence imaging is receiving increased attention in colorectal surgery for improved intraoperative visualization and decision-making. ICG, approved by the U.S. Food and Drug Administration in 1959, rapidly binds to plasma proteins and is primarily intravascular. ICG absorption of near-infrared light (750-800 nm) and emission as fluorescence (830 nm) when bound to tissue proteins enhances deep tissue visualization. Applications include assessing anastomotic perfusion, identifying sentinel lymph nodes, and detecting colorectal cancer metastasis. However, standardized protocols and research on clinical outcomes remain limited. This study explores ICG's role, advantages, disadvantages, and potential clinical impact in colorectal surgery.

Indocyanine green (ICG) imaging has been increasingly used for intraoperative guidance in colorectal surgery over the past decade. The aim of this study was to review and organize, according to different type of use, all available literature on ICG guided colorectal surgery and highlight areas in need of further research and discuss future perspectives.

PubMed, Scopus, and Google Scholar databases were searched systematically through November 2022 for all available studies on fluorescence-guided surgery in colorectal surgery.

Available studies described ICG use in colorectal surgery for perfusion assessment, ureteral and urethral assessment, lymphatic mapping, and hepatic and peritoneal metastases assessment. Although the level of evidence is low, results are promising, especially in the role of ICG in reducing anastomotic leaks.

ICG imaging is a safe and relatively cheap imaging modality in colorectal surgery, especially for perfusion assessment. Work is underway regarding its use in lymphatic mapping, ureter identification, and the assessment of intraperitoneal metastatic disease.