Improving Colorectal Cancer Outcomes by Oncologic Assessment with Fluorescence Imaging
Thursday, July 14, 2016
The outcome of oncologic surgery is dependent upon the treatment of the primary malignancy. In addition to performance of the appropriate curative operation, the administration of preoperative neoadjuvant chemoradiotherapy and postoperative adjuvant chemotherapy are contingent upon staging information. Therefore it is incumbent upon us to gather the most accurate and extensive staging information prior to, during, and after surgery.
One of the most common prognosticators in colorectal cancer is lymph node status. While proper surgical techniques include high ligation and complete mesorectal or mesocolic excision, traditional lymph node staging is contingent upon both the quality and extent of the surgery and also upon the ability of the pathologist to find and assess all extirpated nodes.
Ultrastaging, mesenteric fat clearance techniques, immunohistochemistry evaluation, and sentinel node mapping have all been employed to try to optimize node examination. Indocyanine green (ICG) fluorescence imaging has recently been shown to have significant value in allowing perfusion assessment to try to enhance safety by decreasing the rate of anastomotic leaks following high risk anastomoses.
More recently ICG has also been demonstrated to facilitate and enhance lymph node evaluation in urologic, gynecologic, and colorectal malignancies.
Our summer event will demonstrate the utility of ICG in both the objective assessment of anastomotic perfusion and the improvement in lymph node evaluation in minimally invasive (both laparoscopic and robotic) rectal cancer surgery.
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