Indocyanine green-guided lymphadenectomy and survival of patients with gastric cancer: a systematic review and meta-analysis of time-to-event data
In brief
Indocyanine green-guided surgery linked to 37% lower 3-year death hazard
Across seven studies with 7,518 patients, indocyanine green-guided lymph node surgery was associated with 37% lower death hazard and 32% lower recurrence or death hazard at 3 years. It also removed about seven more lymph nodes on average, without a detected rise in complications. The findings are not proof of cause and effect, and randomized trials are still needed.
- Journal
- Surgical endoscopy (Q1)
- Published
- 8 October 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Yuhang Liu, Han Zou, Yixiang Zhai, Yue Xiong, Qijun Lv
- PMID
- 42850302
- DOI
- 10.1007/s00464-026-13324-0
Why clinicians should know about it
- Picked for Surgery (paper of the day, 11 October 2026): ICG-guided lymphadenectomy improves 3‑year OS and DFS
- Picked for Surgical Oncology (top studies of the week, 11 October 2026): ICG‑guided lymphadenectomy improves survival, increases node yield
Abstract
BACKGROUND: Indocyanine green fluorescence imaging (ICG-FI) is increasingly used for lymph node mapping in gastric cancer (GC) surgery, but its impact on long-term oncologic outcomes remains unclear. This systematic review and meta-analysis evaluated the long-term survival benefits of ICG-guided lymphadenectomy compared with conventional surgery. METHODS: PubMed, Embase, and Cochrane Library were searched from inception to November 2025, supplemented by clinical trial registries. Studies comparing ICG-guided versus non-ICG-guided lymphadenectomy in GC patients were included. Primary outcomes were overall survival (OS) and disease-free survival (DFS). Secondary outcomes included lymph node yield and postoperative complications. Random-effects models were used, and Bayesian analyses estimated the probability of survival benefit. RESULTS: Seven studies comprising 7518 patients were included. ICG significantly improved 3-year OS (HR = 0.635, 95% CI 0.511-0.790, P = 0.000), 3-year DFS (HR = 0.682, 95% CI 0.530-0.877, P = 0.003), and 5-year OS (HR = 0.700, 95% CI 0.507-0.966, P = 0.030), with Bayesian posterior probabilities of 100%, 100%, and 99.1%, respectively. No significant differences were observed for 2-year OS or DFS. ICG significantly increased lymph node yield (WMD = 6.557, 95% C1 3.821-9.294, P = 0.000) without increasing postoperative complications (RR = 0.899, 95% CI 0.647-1.250, P = 0.527). CONCLUSION: ICG-guided lymphadenectomy is associated with improved long-term survival and increased lymph node dissection without increasing complications. These findings support ICG-FI as a valuable adjunct in gastric cancer surgery. Further high-quality randomized trials are warranted to validate these results in diverse populations and settings. PROSPERO REGISTRATION NUMBER: CRD420261342420.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.