Indocyanine green—a potential to explore: narrative review

Objective: Laparoscopic surgery is the standard approach for treatment of early stages of gastric cancer, as there is no evidence to recommend it in more advanced cancers. The minimally invasive technique is associated with some complications, the most concerning of which is anastomotic leakage. Moreover, some aspects of this approach, like lymphadenectomy extension, are still debated. In last years, indocyanine green (ICG) fluorescence imaging was introduced in laparoscopic surgery to improve visualization of anatomical and pathological structures. The purpose of this review article is to delve into all the possible applications of ICG imaging in gastric cancer surgery. Background: After injection, ICG becomes fluorescent when excited either by a laser beam, or by near-infrared light at certain wave lengths. The fluorescence released by ICG can be detected using specifically designated scopes and cameras. In the field of gastric cancer surgery, ICG can be injected intravenously, to visualize arteries and bowel perfusion, or peritumoral, to visualize the tumour and the lymph nodes. Methods: A literature search was performed using PubMed and Embase database to identify relevant articles on ICG fluorescence guided surgery and laparoscopic gastric cancer surgery. Conclusions: More in detail, the paper shows the indications of ICG fluorescence angiography and its association with anastomotic leakage, if compared to standard procedure. Then, it defines the advantages of ICG use to perform the sentinel lymph node mapping, with its application in early gastric cancer. The use of ICG for lymphatic mapping to perform lymphadenectomy is a visual guide and allows to increase the number of lymph nodes harvested. Finally, experimental studies have been published on the use of ICG for and intraoperative identification of peritoneal carcinomatosis.