Intraoperative visualization of lymphatic flow along the ileocolic artery using ICG fluorescence imaging and its implications for right-sided colon cancer surgery.

BACKGROUND

In colorectal cancer surgery, especially for right-sided colon cancer, understanding the anatomical course of lymphatic flow along the ileocolic artery (ICA) is crucial for safe and oncologically adequate mesenteric dissection. However, the precise spatial relationship between the ICA and the accompanying lymphatic vessels has not been well-established.

METHODS

Seventeen patients undergoing laparoscopic right-sided colon cancer surgery were enrolled. Indocyanine green (ICG) was injected into the subserosal layer of the normal ascending colon wall peripheral to the ICA to visualize lymphatic flow. The distance between the lymphatic flow and the ICA was measured intraoperatively using ICG fluorescence imaging.

RESULTS

Lymphatic flow was successfully visualized in 15 of the 17 patients without any complications. After increasing the ICG injection volume to 1.0 mL, lymphatic flow along the ICA was clearly identified in all subsequent 13 cases. The median distance between the lymphatic flow and the ICA was 1.9 cm (interquartile range [IQR], 1.70-2.05 cm). In one case, the flow ran cranially to the ICA and was recorded as 0.0 cm. No major postoperative complications or mesenteric lymph node recurrence were observed during a median follow-up of 3.73 years.

CONCLUSIONS

This study measured the distance between the ICA and the lymphatic flow that ran caudal to the artery, and found a distance of up to approximately 2 cm. These findings may serve as a useful anatomical reference for determining a safe and appropriate mesenteric dissection line in right-sided colon cancer surgery.