Assessment of intraoperative use of indocyanine green fluorescence imaging on the number of lymph node dissection during minimally invasive gastrectomy: a systematic review and meta-analysis

Review question / Objective: Whether is indocyanine green fluorescence imaging-guided lymphadenectomy feasible to improve the number of lymph node dissections during radical gastrectomy in patients with gastric cancer undergoing curative resection? Condition being studied: Gastric cancer was the sixth most common malignant tumor and the fourth leading cause of cancer-related death in the world. Radical lymphadenectomy was a standard procedure in radical gastrectomy for gastric cancer. The retrieval of more lymph nodes was beneficial for improving the accuracy of tumor staging and the long-term survival of patients with gastric cancer. Indocyanine green(ICG) near-infrared fluorescent imaging has been found to provide surgeons with effective visualization of the lymphatic anatomy. As a new surgical navigation technique, ICG near-infrared fluorescent imaging was a hot spot and had already demonstrated promising results in the localization of lymph nodes during surgery in patients with breast cancer, non–small cell lung cancer, and gastric cancer. In addition, ICG had increasingly been reported in the localization of tumor, lymph node dissection, and the evaluation of anastomotic blood supply during radical gastrectomy for gastric cancer. However, it remained unclear whether ICG fluorescence imaging would assist surgeons in performing safe and sufficient lymphadenectomy.