Intraoperative lymphography with indocyanine green experience in liver resection planning in patients with biliary cancer

Purpose of the study was to evaluate the feasibility of intraoperative lymphography with indocyanine green in cholangiocarcinoma and gallbladder cancer.

Patients and methods. The study included 26 patients with biliary cancer, who underwent intraoperative fluorescent lymphography with indocyanine green (ICG lymphography) during the period from April 2023 to January 2025 while planning lymph node (LN) dissection and liver resection. The lymph drainage from the liver and bile ducts was studied at 1, 3, 5, 10, 15, 30 ± 45 minutes from the ICG introduction with the determination of the first three stained LNs – sentinel lymph nodes (SLNs) – followed by subsequent LN dissection with the removal of regional LNs, as well as all stained LNs outside the areas of regional metastases. When technically possible, the planned volume of liver surgery and biliary tract resection was performed.

Results. In two cases (7.7 %) no SLN was detected, in this group there were no metastases in the LNs. In the remaining cases (92.3 %, n = 24), accumulation of ICG in one or more LNs was noted. LN invasion was noted in 12 patients. In this group, when using the first two stained LNs as SLNs, the sensitivity was 91.7 % (n = 11/12). Studying SLN 3 did not affect the sensitivity, but allowed identifying affected LNs outside the areas of regional metastases in two cases (7,7 %).

Conclusion. ICG lymphography is a promising method for determination of the SLNs and lymphatic drainage pathways in biliary cancer. It is advisable to evaluate the effect of LN dissection performed using fluorescence lymphography on long-term outcomes in patients with resectable biliary cancer.

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