Fluorescence guidance using near-infrared fluorescent clips in robotic rectal surgery: a case series

• Published in: International journal of colorectal disease 2024-03, Vol.39 (1), p.41, Article 41
• Main Authors: Narihiro, Satoshi, Nakashima, Syunsuke, Kazi, Mutsumi, Kumamoto, Tomotaka, Kitagawa, Kazuo, Toya, Naoki, Eto, Ken
• Format: Article
• Language: English
• Subjects: Cancer; Chemoradiotherapy; Colorectal cancer; Colorectal carcinoma; Coloring Agents; Fluorescence; Gastroenterology; Hepatology; Humans; I.R. radiation; Internal Medicine; Laparoscopy - methods; Lymph nodes; Lymphatic system; Medicine; Medicine & Public Health; Proctology; Rectal Neoplasms - pathology; Rectal Neoplasms - surgery; Rectum; Rectum - pathology; Rectum - surgery; Retrospective Studies; Robotic surgery; Robotic Surgical Procedures - adverse effects; Robotic Surgical Procedures - methods; Robotics; Surgery; Surgical Instruments; Treatment Outcome; Tumors
• ISSN: 1432-1262; 0179-1958; 1432-1262
• DOI: 10.1007/s00384-024-04615-w

Purpose Tattoo markings are often used as preoperative markers for colorectal cancer. However, scattered ink markings adversely affect tumor site recognition intraoperatively; therefore, interventions for rectal cancer may lead to an inaccurate distal resection margin (DRM) and incomplete total mesorectal excision (TME). This is the first case series of fluorescence-guided robotic rectal surgery in which near-infrared fluorescence clips (NIRFCs) were used to localize rectal cancer lesions. Methods We enrolled 20 consecutive patients who underwent robotic surgery for rectal cancer between December 2022 and December 2023 in the current study. The primary endpoints were the rate of intraoperative clip detection and its usefulness for marking the tumor site. Secondary endpoints were oncological assessments, including DRM and the number of lymph nodes. Results Clip locations were confirmed in 17 of 20 (85%) patients. NIRFCs were not detected in 3 out of 7 patients who underwent preoperative chemoradiation therapy. No adverse events, including bleeding or perforation, were observed at the time of clipping, and no clips were lost. The median DRM was 55 mm (range, 22–86 mm) for rectosigmoid (Rs), 33 mm (range, 16–60 mm) for upper rectum (Ra), and 20 mm (range, 17–30 mm) for low rectum (Rb). The median number of lymph nodes was 13 (range, 10–21). Conclusion The rate of intraoperative clip detection, oncological assessment, including DRM, and the number of lymph nodes indicate that the utility of fluorescence-guided methods with NIRFCs is feasible for rectal cancer.