A Narrative Review of Intraoperative Use of Indocyanine Green Fluorescence Imaging in Gastrointestinal Cancer - Situation and Future Directions

Sep 24, 2026

Uploaded by Riley

A narrative review examines the intraoperative use of indocyanine green (ICG) fluorescence imaging in gastrointestinal cancers, focusing on current applications and administration practices. The review evaluates how ICG helps localize tumors, visualize lymph nodes in real time, and potentially improve surgical accuracy and outcomes. Key controversies include non-uniform ICG dosing and administration, limited high-level evidence for certain indications, and persistent challenges such as false negatives in sentinel lymph node detection for gastric cancer. Future research directions and the need for standardized guidelines are discussed.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages19

Reading Time48 min

AccessFree to download

Background and Objective

Methods

Key Content and Findings

Conclusions

Keywords

A narrative review of intraoperative use of indocyanine green fluorescence imaging in gastrointestinal cancer: situation and future directions Han Li1\#, Xiaozhou Xie2\#, Fengying Du2, Xingyu Zhu2, Huicheng Ren2, Chunshui Ye2,3, Zhaodong Liu2, Yulong Zhao2, Xinshuai Yu2,3, Chi Zhang2,3, Liang Shang2, Leping Li2 1Department of Gastrointestinal Surgery, the First Affiliated Hospital of Shandong First Medical University, Shandong Provincial Qianfoshan Hospital, Jinan, China; 2Department of Gastrointestinal Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong Provincial Laboratory of Translational Medicine Engineering for Digestive Tumors, Shandong Provincial Hospital, Jinan, China; 3Cheeloo College of Medicine, Shandong University, Jinan, China Contributions: (I) Conception and design: L Shang; (II) Administrative support: L Li; (III) Provision of study materials or patients: L Li, L Shang; (IV) Collection and assembly of data: X Xie; (V) Data analysis and interpretation: H Li; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. \#These authors contributed equally to this work. Correspondence to: Liang Shang, PhD; Leping Li, PhD. Department of Gastrointestinal Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong Provincial Laboratory of Translational Medicine Engineering for Digestive Tumors, Shandong Provincial Hospital, No. 324, Jingwuweiqi Road, Huaiyin District, Jinan, China. Email: [docshang@163.com](docshang@163.com); [lileping@medmail.com.cn](lileping@medmail.com.cn). Background and Objective: As a surgical tool, indocyanine green (ICG) is increasingly used in surgery, especially in gastric and colorectal surgery. The use of ICG fluorescence imaging can improve the accuracy of tumor resection and potentially improve surgical outcomes for cancer patients. However, there are still different opinions or controversies on the application of ICG in the literature and the administration ofICGis still not uniform. In this review, we summarize the current status of its application and ICG administration methods in gastrointestinal cancer and discuss its existing limitations and future research directions. Methods: Literature published in the PubMed database from 1969 to 2022 was searched for using the keywords “Indocyanine green or near-infrared imaging or ICG”,“gastric cancer”,“gastroesophageal junction cancer”, and “colorectal cancer” to summarize the main applications of ICG in gastrointestinal cancers. Key Content and Findings: ICG guidance can rapidly determine tumor location and save operative time, and can also visualize lymph nodes (LNs) in real-time, helping surgeons to retrieve more LNs for better postoperative staging, but its use in identifying sentinel lymph node (SLN) in gastric cancer (GC) remains controversial due to false negatives. ICG fluorescent angiography has great potential in preventing colorectal anastomotic leakage, but there is a dearth of high-caliber research evidence. In addition, ICG has unique advantages in detecting colorectal liver micrometastasis. Notably, there is still no uniform administration method and dose ofICG. Conclusions: In this review, we summarize the current status ofICG application in gastrointestinal cancer, and the current literature suggests that it is safe and effective and has the potential to change the clinical outcome of patients. Therefore, ICG should be routinely used in gastrointestinal cancers to improve the surgical outcomes of patients. In addition, this review summarizes the ICG administration in the literature, and we expect future guidelines to unitize and standardize the administration ofICG. Keywords: Indocyanine green (ICG); gastrointestinal cancer; gastric cancer (GC); colorectal cancer (CRC); liver metastasis Submitted Feb 16, 2023. Accepted for publication Apr 20, 2023. Published online Apr 26, 2023. doi:

FAQs

What is the main purpose of using ICG fluorescence imaging during gastrointestinal cancer surgery?

To improve intraoperative tumor localization and accuracy of tumor resection, while also enabling real-time visualization of lymph nodes to support better staging and surgical decision-making.

What controversies or limitations are highlighted in the literature review?

ICG administration and dosing are not standardized, and evidence quality is limited for some applications. In gastric cancer, sentinel lymph node identification remains controversial due to false negatives.

What future direction does the review emphasize?

Development of future guidelines to standardize ICG administration and unify practices, supported by further high-quality research to address current evidence gaps.

Sep 24, 2026

Uploaded by Riley