Application Of Indocyanine Green In D3 Radical Resection Of Rectal Cancer With Preservation Of Left Colic Artery

Objective: To study the advantage and security of ICG in D3 lymph node contextualization dissection during radical rectal cancer surgery with preservation of the left colonic artery(LCA)and autonomic nerves around the inferior mesenteric artery(IMA).Methods:This study included the data of 96 patients who underwent D3 radical resection for rectal cancer with the LCA and the IMA peripheral autonomic nerve preserved from September 2020 to July 2022.This included 51 patients with ICG lymph node dissection(experimental group)and 45 patients who did not use ICG for lymph node dissection.Independent sample t test,Chi-square test,median(M)and interquartile distance(IQR)were used to compare the intraoperative situation(operation time,intraoperative blood loss),postoperative lymph node detection(The total number of lymph nodes dissected,the number of lymph nodes dissected in 253 groups and the number of positive lymph nodes dissected)and the postoperative recovery and complications of the two groups.The IPSS scores of the experimental group before and 6 months after surgery were compared by paired sample Mann-Whitney U test;The IPSS scores of the control group before and 6 months after surgery were compared by paired sample Mann-Whitney U test.Results:1、 General information: There were no significant differences in age,sex,BMI,ASA grade,TNM stage and tumor location between the experimental group and the control group.2、 Intraoperative lymph node dissection:The number of total lymph nodes detected in ICG group and control group was 16.3±3.4 and 13.3±2.6,respectively(P < 0.05);The total number of positive lymph node dissection in ICG group and control group was 3.5±1.5 and 2.5±1.3,respectively(P <0.05);The median of 253 positive lymph nodes in ICG group was 2.0(1.0,3.0)compared with 1.0(1.0,1.0)in control group(P < 0.05).3 、 Perioperative postoperative recovery and complications: There were no significant differences between the ICG group and the control group in operation time,intraoperative blood loss,White blood cell count the first day after surgery,retention catheter time,first exhaust time,first getting out of bed time,first liquid feeding time,abdominal drainage tube removal time,postoperative hospitalization time and postoperative complications.4、 The content of follow-up: The median IPSS scores before and 6months after surgery were 4(2.0,5.0)and 4(3.0,5.0)in the ICG group(P > 0.05);4(2.0,5.5)and 4(2.0,5.5)in control group(P > 0.05).Conclusion:1、 The application of ICG in the D3 radical operation of rectal cancer with the preservation of LCA and IMA peripheral nerves,dissection of lymph nodes in 253 groups has certain advantages,ICG tracer effect can increase the number of total lymph nodes,total positive lymph nodes and lymph nodes dissection in 253 groups to a certain extent.Fully reflects the advantages of ICG lymph node dissection.2、 The application of ICG is safe and feasible,the use of ICG does not increase intraoperative blood loss,operation time,or complications,nor does it affect patients’ perioperative postoperative recovery.3、 Urination function was not affected by D3 radical resection of rectal cancer with LCA and IMA peripheral autonomic nerves preserved.On this basis,ICG increased the number of lymph node dissection.It makes the evaluation of postoperative tumor stage more accurate and has guiding significance for postoperative comprehensive treatment of patients.