The contrubitions of lymphangiography with fluorescence imaging in right sided colon cancer surgery, A retrospective investigation

Colorectal cancer is the third most common cancer worldwide. Since 5-year survival can range from 90% in early disease to 10% in metastatic disease, nodal involvement is one of the important factors affecting survival. It has been proven that the number of lymph nodes collected in colon cancer surgery is directly proportional to the prognosis. To improve the results, the complete mesocolic excision (CME) technique has been described. Collecting more lymph nodes is one of the main goals in CME technique. New methods to be developed to collect more lymph nodes in colon cancer surgery are of great importance. The importance of new methods to be developed to collect more lymph nodes in colon cancer surgery is considerable. Fluorescence imaging technology enables lymphangiography and lymphatic mapping. The data of patients were analyzed who underwent colectomy surgery using lymphatic mapping technique with submucosal indocyanine green (ICG) injection to the anterior and posterior surfaces and the peritumoral area at certain levels of the right colon. There was no difference in age, ASA score, tumor location, tumor T and N stages, and pathological markers affecting prognosis between 10 patients (group S) who underwent lymphatic mapping and 20 patients (group C) compared at a ratio of 1:2. The operation times of the two groups were similar. Although 10% of intraoperative complications were seen in group C, it was not statistically significant (p=0.540). After lymphangiography, lymph nodes containing ICG were detected in the resection site and these lymph nodes were sent to pathology in separate containers. Considering the number of lymph nodes sent separately, it was determined that significantly more lymph nodes were sent in the S group (p=0.001). In our study, where we showed that the lymphatic mapping technique with ICG can be safely applied in the surgical treatment of right colon cancer, without prolonging the operation time, we have shown that we can expand the limits of lymphadenectomy with lymph nodes that are left in the resection area and are excised separately, and that we do not increase intraoperative complications, especially including vascular injuries, by lymphangiography. Thus, selective D3 lymph node dissection may be possible, avoiding vascular injury, which is an important problem of CME.