Utilization of Indocyanine green to demonstrate lymphatic mapping in colon cancer.
Deborah S. Keller M.D.
Joshi, H. M., D. S. Keller and M. Chand (2017). “Utilization of indocyanine green to demonstrate lymphatic mapping in colon cancer.” J Surg Oncol: 2017 Oct [Epub ahead of print].
The principles of oncologic resection for colon cancer are based on excising the primary tumor with its blood supply and associated lymph node basin. While resection of the tumor and its named vessel are relatively consistent, the extent of the mesenteric lymphadenectomy can be variable, which affects the quality of the specimen and nodal yield, and potentially the survival outcomes for the patient through under-staging. According to The Royal College of Pathologists and The College of American Pathologists, an adequate colonic oncological resection requires a minimum of 12 nodes to be removed but there is accumulating evidence this is still a substandard lymph node yield. Proponents of complete mesocolic excision (CME) argue that performing more radical surgery with a larger mesenteric specimen results in a greater number of lymph nodes and potentially improved survival outcomes. However, there is no current consensus for a CME approach, and there are concerns for increased morbidity after extended lymph node dissection. In addition, while studies have shown value, the role of the sentinel lymph node biopsy is still undefined in colon cancer staging.