Intraoperative indocyanine green lymphography during lymph node dissection in patients with colorectal cancer liver metastases
A. V. Korshak,
D. V. Podluzhnyi,
A. G. Kotelnikov,
V. I. Egorov,
M G. Abgaryan,
M. V. Batalova,
G. G. Makiev,
A. A. Tryakin,
D. M. Kantieva,
M. Sh. Manukyan,
A. N. Polyakov https://doi.org/10.17709/2410-1893-2026-13-1-2
EDN: BKHIPW
Abstract
Purpose of the study. To evaluate the diagnostic performance of intraoperative fluorescence lymphography in patients with colorectal liver metastases (CLM).
Patients and methods. The study included 55 patients with CLM who underwent intraoperative fluorescence lymphography with indocyanine green (ICG) during laparotomy to guide hepatic hilum lymph node dissection (LND) and liver resection. The first three fluorescent lymph nodes (LNs), defined as sentinel lymph nodes (SLNs), were identified within 30–45 minutes after peritumoral ICG injection. LND was performed with excision and labeling of SLNs and all fluorescent LNs detected during the observation period, as well as lymph nodes from stations 12, 13, and 8, regardless of fluorescence. Liver resection was subsequently performed.
Results. In six of 55 patients (10.9 %), no SLNs were visualized. These patients underwent LND with removal of lymph nodes from stations 12, 8, and 13; histopathological examination revealed no LN metastases in this subgroup. In the remaining patients (89.1 %, n = 49), SLN fluorescence was observed. Histopathological analysis demonstrated lymphogenous metastases in 11 of 55 patients (20.0 %). In four of these 11 patients (36.3 %), selective LND based solely on preoperative imaging and intraoperative assessment would have failed to identify and remove metastatic LNs. The sensitivity of ICG lymphography was 100 %: in all 11 patients with nodal metastases, at least one SLN (SLN No1, No2, or No3) was involved. In two cases (18.2 %), metastatic involvement was detected only in SLN No3, with SLN No1 and SLN No2 being negative. Only one of the 11 patients (9.1 %) had additional metastatic LNs beyond the SLN basin; in this patient, all three SLNs were metastatic.
Conclusion. Hepatic hilum LN metastases were detected in one in five patients with CLM. Reliable preoperative or intraoperative identification of metastatic hilar LNs remains challenging. ICG-guided SLN mapping enables more precise lymph node dissection. Further studies are required to determine whether this approach improves long-term oncological outcomes after liver resection for CLM.
Patients and methods. The study included 55 patients with CLM who underwent intraoperative fluorescence lymphography with indocyanine green (ICG) during laparotomy to guide hepatic hilum lymph node dissection (LND) and liver resection. The first three fluorescent lymph nodes (LNs), defined as sentinel lymph nodes (SLNs), were identified within 30–45 minutes after peritumoral ICG injection. LND was performed with excision and labeling of SLNs and all fluorescent LNs detected during the observation period, as well as lymph nodes from stations 12, 13, and 8, regardless of fluorescence. Liver resection was subsequently performed.
Results. In six of 55 patients (10.9 %), no SLNs were visualized. These patients underwent LND with removal of lymph nodes from stations 12, 8, and 13; histopathological examination revealed no LN metastases in this subgroup. In the remaining patients (89.1 %, n = 49), SLN fluorescence was observed. Histopathological analysis demonstrated lymphogenous metastases in 11 of 55 patients (20.0 %). In four of these 11 patients (36.3 %), selective LND based solely on preoperative imaging and intraoperative assessment would have failed to identify and remove metastatic LNs. The sensitivity of ICG lymphography was 100 %: in all 11 patients with nodal metastases, at least one SLN (SLN No1, No2, or No3) was involved. In two cases (18.2 %), metastatic involvement was detected only in SLN No3, with SLN No1 and SLN No2 being negative. Only one of the 11 patients (9.1 %) had additional metastatic LNs beyond the SLN basin; in this patient, all three SLNs were metastatic.
Conclusion. Hepatic hilum LN metastases were detected in one in five patients with CLM. Reliable preoperative or intraoperative identification of metastatic hilar LNs remains challenging. ICG-guided SLN mapping enables more precise lymph node dissection. Further studies are required to determine whether this approach improves long-term oncological outcomes after liver resection for CLM.
About the Authors
A. V. Korshak
https://www.ronc.ru
N. N. Blokhin National Medical Research Center of Oncology
N. N. Blokhin National Medical Research Center of Oncology
Moscow, Russian Federation
Alina V. Korshak – MD, Oncologist, Department of Abdominal Oncology No. 2 (tumors of the hepatopancreatobiliary zone), N.N. Blokhin National Medical Research Center of Oncology, Moscow, Russian Federation ORCID: https://orcid.org/0009-0002-8236-2808 Scopus Author ID: 58681896200
Competing Interests:
The author declares that there are no obvious and potential conflicts of interest related to the publication of this article.
D. V. Podluzhnyi
https://new.nmicr.ru/mrrc/
A.Tsyb Medical Radiological Research Centre – Branch of the National Medical Research Radiological Centre
A.Tsyb Medical Radiological Research Centre – Branch of the National Medical Research Radiological Centre
Obninsk, Russian Federation
Danil V. Podluzhny – Cand. Sci. (Medicine), oncologist, Abdominal Department, A.Tsyb Medical Radiological Research Centre – Branch of the National Medical Research Radiological Centre, Obninsk, Russian Federation ORCID: https://orcid.org/0000-0001-7375-3378 eLibrary SPIN: 3537-3436, AuthorID: 583879 Scopus Author ID: 56801896900
Competing Interests:
The author declares that there are no obvious and potential conflicts of interest related to the publication of this article.
A. G. Kotelnikov
https://www.ronc.ru
N. N. Blokhin National Medical Research Center of Oncology
N. N. Blokhin National Medical Research Center of Oncology
Moscow, Russian Federation
Alexey G. Kotelnikov – Dr. Sci. (Medicine), Professor, Leading Researcher of the Department of abdominal oncology No. 2 (tumors of the hepatopancreatobiliary zone), N.N. Blokhin National Medical Research Center of Oncology, Moscow, Russian Federation ORCID: https://orcid.org/0000-0002-2811-0549 eLibrary SPIN: 8710-4003, AuthorID: 105352 Scopus Author ID: 7005528750
Competing Interests:
The author declares that there are no obvious and potential conflicts of interest related to the publication of this article.
V. I. Egorov
https://www.ronc.ru
N. N. Blokhin National Medical Research Center of Oncology, Moscow, Russian Federation;
N. N. Blokhin National Medical Research Center of Oncology, Moscow, Russian Federation;
Kazan State Medical University, Kazan, Russian Federation;
Republican Clinical Oncological Dispensary named after Profess or M.Z. Sigal, Kazan, Russian Federation
Vasiliy I. Egorov – Cand. Sci. (Medicine), Assistant of the Department of Oncology, Diagnostic Radiology and Radiation Therapy, Kazan State Medical University, Kazan, Russian Federation; MD, Oncologist, Republican Clinical Oncological Dispensary named after Professor M.Z. Sigal, Kazan, Russian Federation; Postgraduate Researcher (Applicant), Department of Abdominal Oncology No. 2, N.N. Blokhin National Medical Research Center of Oncology, Moscow, Russian Federation ORCID: https://orcid.org/0000-0002-6603-1390 eLibrary SPIN: 7794-4210, AuthorID: 829829 Scopus Author ID: 7202505136
Competing Interests:
The author declares that there are no obvious and potential conflicts of interest related to the publication of this article.
M G. Abgaryan
https://www.ronc.ru
N. N. Blokhin National Medical Research Center of Oncology
N. N. Blokhin National Medical Research Center of Oncology
Moscow, Russian Federation
Mikael G. Abgaryan – Cand. Sci. (Medicine), Senior Research Fellow, Medical Oncologist, Department of Abdominal Oncology No. 1, N.N. Trapeznikov Research Institute of Clinical Oncology, N.N. Blokhin National Medical Research Center of Oncology, Moscow, Russian Federation ORCID: https://orcid.org/0000-0001-8893-1894 eLibrary SPIN: 1821-6900, AuthorID: 601950 Scopus Author ID: 57193874192
Competing Interests:
The author declares that there are no obvious and potential conflicts of interest related to the publication of this article.
M. V. Batalova
https://gkb-buyanova.ru
V. M. Buyanov City Clinical Hospital
V. M. Buyanov City Clinical Hospital
Moscow, Russian Federation
Maria V. Batalova – Cand. Sci. (Medicine), radiologist of the Diagnostic Radiology Department, Buyanov City Clinical Hospital, Moscow, Russian Federation
Competing Interests:
The author declares that there are no obvious and potential conflicts of interest related to the publication of this article.
G. G. Makiev
https://www.ronc.ru
N. N. Blokhin National Medical Research Center of Oncology
N. N. Blokhin National Medical Research Center of Oncology
Moscow, Russian Federation
Georgii G. Makiev – MD, Oncologist, PhD Student, Department of Anticancer Drug Therapy No. 2, Division of Drug Treatment Methods, N.N. Trapeznikov Research Institute of Clinical Oncology, N.N. Blokhin National Medical Research Center of Oncology, Moscow, Russian Federation ORCID: https://orcid.org/0000-0001-9732-4033 eLibrary SPIN: 5068-0705, AuthorID: 999008 Scopus Author ID: 59202759300
Competing Interests:
The author declares that there are no obvious and potential conflicts of interest related to the publication of this article.
A. A. Tryakin
https://www.ronc.ru
N. N. Blokhin National Medical Research Center of Oncology
N. N. Blokhin National Medical Research Center of Oncology
Moscow, Russian Federation
Alexey A. Tryakin – Dr. Sci. (Medicine), Professor, Deputy Director for Research, N.N. Trapeznikov Research Institute of Clinical Oncology, Head of the Department of Anticancer Drug Therapy No. 2, Division of Drug Treatment Methods, N.N. Trapeznikov Research Institute of Clinical Oncology, N.N. Blokhin National Medical Research Center of Oncology, Moscow, Russian Federation ORCID: https://orcid.org/0000-0003-2245-214X eLibrary SPIN: 7708-5775, AuthorID: 122803 Scopus Author ID: 6505503514 WoS ResearcherID: E-6094-2015
Competing Interests:
The author declares that there are no obvious and potential conflicts of interest related to the publication of this article.
D. M. Kantieva
https://www.ronc.ru
N. N. Blokhin National Medical Research Center of Oncology
N. N. Blokhin National Medical Research Center of Oncology
Moscow, Russian Federation
Dayana M. Kantieva – MD, Interventional Radiologist, Department of Endovascular Diagnosis and Treatment, Division of Interventional Radiology, Research Institute of Clinical and Experimental Radiology, N.N. Blokhin National Medical Research Center of Oncology, Moscow, Russian Federation ORCID: https://orcid.org/0000-0003-3953-0036 Scopus Author ID: 57216418049 WoS ResearcherID: GLV-5759-2022
Competing Interests:
The author declares that there are no obvious and potential conflicts of interest related to the publication of this article.
M. Sh. Manukyan
https://www.ronc.ru
N. N. Blokhin National Medical Research Center of Oncology
N. N. Blokhin National Medical Research Center of Oncology
Moscow, Russian Federation
Mariam Sh. Manukyan – MD, Oncologist, Research Fellow, Department of Anticancer Drug Therapy No. 2, Division of Drug Treatment Methods, N.N. Trapeznikov Research Institute of Clinical Oncology, N.N. Blokhin National Medical Research Center of Oncology, Moscow, Russian Federation ORCID: https://orcid.org/0000-0002-5084-4872, eLibrary SPIN: 1546-6035 AuthorID: 1160450
Competing Interests:
The author declares that there are no obvious and potential conflicts of interest related to the publication of this article.
A. N. Polyakov
https://www.ronc.ru
N. N. Blokhin National Medical Research Center of Oncology
N. N. Blokhin National Medical Research Center of Oncology
Moscow, Russian Federation
Alexander N. Polyakov – Dr. Sci. (Medicine), Senior Researcher, Department of Abdominal Oncology No. 2 (tumors of the hepatopancreatobiliary zone, N.N. Blokhin National Medical Research Center of Oncology, Moscow, Russian Federation ORCID: https://orcid.org/0000-0001-5348-5011 eLibrary SPIN: 9924-0256, AuthorID: 764535 Scopus Author ID: 57190413973 WoS ResearcherID: ABB-8912-2021
Competing Interests:
The author declares that there are no obvious and potential conflicts of interest related to the publication of this article.
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Korshak A.V., Podluzhnyi D.V., Kotelnikov A.G., Egorov V.I., Abgaryan M.G., Batalova M.V., Makiev G.G., Tryakin A.A., Kantieva D.M., Manukyan M.Sh., Polyakov A.N. Intraoperative indocyanine green lymphography during lymph node dissection in patients with colorectal cancer liver metastases. Research and Practical Medicine Journal. 2026;13(1):18-30. https://doi.org/10.17709/2410-1893-2026-13-1-2. EDN: BKHIPW
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