Preoperative tumor marking with indocyanine green (ICG) prior to minimally invasive colorectal cancer: a systematic review of current literature

Michael K Konstantinidis; Argyrios Ioannidis; Panteleimon Vassiliu; Nikolaos Arkadopoulos; Ioannis S Papanikolaou; Konstantinos Stavridis; Gaetano Gallo; Dimitrios Karagiannis; Manish Chand; Steven D Wexner; Konstantinos Konstantinidis

doi:10.3389/fsurg.2023.1258343

Preoperative tumor marking with indocyanine green (ICG) prior to minimally invasive colorectal cancer: a systematic review of current literature

Front Surg. 2023 Aug 11:10:1258343. doi: 10.3389/fsurg.2023.1258343. eCollection 2023.

Affiliations

¹ Department of General, Laparoscopic, Oncologic and Robotic Surgery, Athens Medical Center, Athens, Greece.
² Fourth Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece.
³ Hepatogastroenterology Unit, Second Department of Internal Medicine-Propaedeutic, Medical School, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece.
⁴ 2nd Department of Obstetrics and Gynaecology, Aretaieion Hospital, University of Athens, Athens, Greece.
⁵ Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy.
⁶ Department of Gastroenterology and Hepatology, Athens Medical Center, Athens, Greece.
⁷ UCL Division of Surgery and Interventional Sciences, WEISS Centre, University College London, London, United Kingdom.
⁸ Department of Colorectal Surgery, Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, United States.

Abstract

Aim: To describe the currently available evidence regarding the efficacy and safety of preoperative tumor marking using indocyanine green (ICG) prior to laparoscopic or robotic colorectal resections.

Methods: A systematic search for relevant studies was conducted using the following databases: Embase (OVID), MEDLINE® (OVID), APA PsycInfo (OVID), Global Health (OVID) and HMIC Health Management Information Consortium (OVID) through June 2022 reported according to PRISMA 2020 guidelines. Primary outcome was the detection rate of the tumor sites preoperatively marked with ICG. Secondary outcomes were timing of ICG injection in days prior to the operation and technique-related complications.

Results: Eight single center studies, published between 2008 and 2022, were identified yielding a total of 1,061 patients, of whom 696 were preoperatively tattooed with ICG. Injection dosage of diluted ICG ranged from 0.1-1.5 ml. Four studies used the saline test injection method prior to ICG injection. When the marking was placed within one week, the visualization rate was 650/668 (97%), whereas when it was longer than one week, the detection rate was 8/56 (14%). No severe complications were reported.

Conclusion: Preoperative tumor marking using ICG prior to minimally invasive colorectal resections is safe and effective, allowing intraoperative tumor site location when performed up to a week prior to surgery without disturbing the surgical view in potential mild complications.

Keywords: colorectal cancer; colorectal surgery; colorectal tumor; fluorescence imaging; indocyanine green; preoperative tattoo; preoperative tumor marking.

Publication types

Review