Application of ICG in Lymph Node Dissection During Radical Resection of Rectal Cancer With Preserved Autonomic Nerves Around LCA and IMA
Condition: Indocyanine Green
MeSH terms: Rectal Neoplasms
Study type: Interventional

Summary: 
      Indocyanine green NIR imaging is valuable for lymph node dissection in D3 radical surgery for
      rectal cancer. It can guide the intraoperative improvement of lymph node dissection based on
      the preservation of LCA and peripheral autonomic nerves of IMA. This not only reduces the
      occurrence of postoperative complications and promotes rapid postoperative recovery, but also
      provides a more precise and individualized comprehensive treatment plan for patients after
      surgery. In addition，this trial also demonstrated that ICG is safe and feasible for use in
      rectal cancer
    

Detailed description: 
      The pathological data of 96 patients with rectal cancer from September 2020 - July 2022 were
      collected from the First Hospital of Qinhuangdao City.In 51 of these patients, ICG was
      injected preoperatively via anoscope or anal dilator in the mucosal layer around the tumor,
      and surgical treatment was performed after visualization. The surgical approach was performed
      by laparoscopic radical rectal cancer with an intermediate approach step.The IMA root is
      treated with low ligation of the IMA, while lymph node dissection is performed while
      preserving the autonomic nerves around the IMA. The other 45 patients were not injected with
      ICG, and the procedure was performed as before.The occurrence of postoperative complications
      was recorded, and the detection of lymph nodes was also compared between the two groups, as
      well as the intraoperative situation and postoperative recovery.
    

Intervention name(s): non-ICG; ICG
Intervention type(s): Other; Drug
Intervention description(s): Laparoscopic radical resection of rectal cancer was performed routinely without ICG injection. The separation should extend from the center to the left, reaching the left paracolic sulcus lateral to the genital vessels. The Superior hypogastric nerve is protected by freeing it at the angle of the common iliac artery on both sides, afterwards, the vessel is free along the surface of the plexus from caudal to cephalic side to reach the root of the IMA. Switching lymph node visualization patterns. Based on the operator's experience and the extent of lymph node visualization, the lymph nodes at the root of the IMA were removed with an ultrasonic knife . The dissection continues caudally along the IMA, preserving the arterial sheath. Expose the left colonic artery, superior rectal artery, and sigmoid artery, maximum preservation of the IMA peripheral plexus while clearing their surrounding lymph nodes.; Dilute ICG to 2.5 mg/ml with its accompanying sterilized water for injection. Slow injection with a 1ml syringe in 4 parts of the tumor，Inject 0.25ml per site . Procedure started after lymph node visualization.The operation was consistent with the control group.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Care Provider)
Primary purpose: Prevention
Keywords: Indocyanine Green; Rectal Cancer; Autonomic nerve; Inferior mesenteric artery; Left colic artery; lymph nodes