Fluorescence-guidance using near-infrared fluorescent clips in robotic rectal surgery: a case series

Author:

Narihiro Satoshi1,Nakashima Syunsuke1,Kazi Mutsumi1,Kumamoto Tomotaka1,Kitagawa Kazuo1,Toya Naoki1,Eto Ken2

Affiliation:

1. Department of Surgery, The Jikei University Kashiwa Hospital

2. Department of Surgery, The Jikei University School of Medicine

Abstract

Abstract Tattoo markings are often used as preoperative markers for colorectal cancer. However, scattered ink markings adversely affects tumor site recognition intraoperatively; therefore, interventions for rectal cancer may lead to an inaccurate distal resection margin (DRM) and incomplete total mesorectal excision (TME). This is the first case series of fluorescence-guided robotic rectal surgery in which near-infrared fluorescence clips (NIRFCs) were used to localize rectal cancer lesions. Twenty consecutive patients who underwent robotic surgery for rectal cancer between December 2022 and December 2023 were enrolled in the study. The primary endpoints of this study were the rate of intraoperative clip detection and its usefulness for marking the tumor site. Secondary endpoints were oncological assessments, including DRM and the number of lymph nodes. Clip locations were confirmed in 17 of 20 (85%) cases. There were seven (35%) cases with preoperative CRT and, of these, the detection of NIRFC was affected in 3 cases. No adverse events, including bleeding or perforation, were observed at the time of clipping, and no clippings were lost. The median DRM was 55 mm (range, 22–86 mm) for Rs, 33 mm (range, 16–60 mm) for Ra, and 20 mm (range, 17–30 mm) for Rb. The median number of lymph nodes was 13 (range, 10–21 mm). The rate of intraoperative clip detection, oncological assessment, including DRM, and the number of lymph nodes indicate that fluorescence-guided methods using NIRFCs are feasible for rectal cancer.

Publisher

Research Square Platform LLC

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