Indocyanine green fluorescence–guided navigation during gastrectomy for resectable gastric cancer: A systematic review and meta-analysis.

Abstract

e16147 Background: Radical gastrectomy with lymphadenectomy is the standard surgical approach for curative treatmentof gastric cancer. Adequate lymph node retrieval is critical for accurate pathologic staging andsurgical quality. Indocyanine green (ICG) fluorescence–guided navigation has been introduced as anadjunct to standard gastrectomy to enhance lymphatic mapping; however, randomized studies havereported variable effects on nodal outcomes. A meta-analysis was conducted to compare ICG-guidednavigation versus standard gastrectomy using head-to-head randomized evidence. Methods: A systematic search was conducted in PubMed, Embase, and the Cochrane Central Register ofControlled Trials from inception to January 2026 to identify randomized controlled trials comparingICG-guided navigation versus standard gastrectomy in patients undergoing curative resection forgastric cancer. Eligible studies reported lymph node retrieval outcomes. Pooled analyses wereperformed using inverse-variance methods; results were expressed as mean differences (MDs) with95% confidence intervals (CIs). Results: Three randomized controlled trials were included, enrolling 209 patients (ICG n = 105; No-ICGn = 104). Total retrieved lymph nodes were significantly higher with ICG guidance (MD 12.70; 95% CI8.55–16.86; P < 0.00001; I² = 0%). In contrast, the number of positive lymph nodes did not differsignificantly between groups (MD 1.39; 95% CI −0.89 to 3.66; P = 0.23; I² = 0%). Overallheterogeneity was minimal across pooled outcomes. Conclusions: ICG-guided navigation during gastrectomy was associated with a significantly higher total lymphnode yield compared with standard surgery, supporting improved nodal retrieval for staging quality.However, the number of positive lymph nodes was comparable between approaches. These findingssupport the intraoperative utility of ICG guidance to enhance lymph node harvest, while underscoringthe need for larger randomized trials with standardized oncologic and long-term outcomes to define itsoptimal role in gastric cancer surgery.