The Short and Long Oncological Outcome of Indocyanine Green for Lateral Lymph Node Dissection in Mid-low Rectum Cancer

Background Lateral lymph node dissection (LLND) is a key component of surgical treatment for locally advanced mid-to-lower rectal cancer. While indocyanine green (ICG) fluorescence guidance has been proposed to enhance surgical precision, its impact on long-term oncological outcomes remains unclear. Methods This retrospective, multicenter study compared ICG-assisted laparoscopic LLND (ICG-LND) with conventional laparoscopic LLND in patients with mid-to-lower rectal cancer between January 2018 and June 2022. Outcomes included 3-year overall survival (OS), recurrence-free survival (RFS), local recurrence rates, and distant metastasis rates. Kaplan-Meier analysis and Cox proportional hazards regression models were used to evaluate survival outcomes. Results The study included 258 patients (ICG-LND: 79; control: 179). The ICG-LND group had a slightly higher median number of harvested lateral lymph nodes (9 [IQR: 5–13] vs. 7 [IQR: 4–13]), but the difference was not significant (P = 0.611). Similarly, positive lateral lymph node counts showed no significant difference (P = 0.455). Median postoperative hospital stays were shorter in the ICG-LND group (6 [IQR: 5–8] vs. 7 [IQR: 6–9] days, P < 0.001). Survival analysis showed no significant differences between groups in OS (5-year: 84.6% vs. 86.1%, P = 0.884), RFS, or recurrence rates (local: 6.3% vs. 6.7%; distant: 10.1% vs. 10.8%). Conclusion ICG-LND shortens postoperative recovery but does not enhance long-term oncological outcomes, including survival and recurrence rates. Further prospective studies are needed to validate its prognostic value.