New imaging technique improves precision in bladder cancer surgery

Bladder cancer is one of the most common malignant tumors in urinary system, and the treatment faces huge challenges. Radical cystectomy (RC) is the primary treatment for invasive cases, yet the prognosis remains grim due to lymph node metastasis. Pelvic lymph node dissection (PLND) plays a vital role in improving survival rates and optimizing treatment strategies. Despite its importance, the methods and scope of PLND remain contentious, and the procedure itself may be difficult with risks of damaging nearby organs and nerves. These challenges highlight the urgent need for more precise surgical techniques in PLND.

On July 16, 2024, a study (DOI: 10.1002/uro2.70) published in UroPrecision unveiled a promising new approach to bladder cancer surgery. Researchers from the First Hospital of Shanxi Medical University have developed a technique that utilizes indocyanine green (ICG) and fluorescent imaging to guide PLND, offering a more accurate and efficient alternative to traditional methods.

The study was conducted in Shanxi Medical University's First Hospital involving 54 patients undergoing RC and PLND. It showed a novel approach that injecting the ICG into the medial malleolus of both lower limbs and the perineum. Meanwhile, surgeons could be able to track the flow of ICG through the lymphatic system via a 4K fluorescent laparoscopic imaging system, pinpointing and removing lymph nodes with unprecedented precision. The results were compelling: this dual injection method reduced PLND surgery time by an average of 6.2 minutes and improved the accuracy of lymph node dissection to 93.41%, compared to just 75.91% in the control group, which did not utilize ICG guidance. This technique not only streamlined the surgical process but also promises better patient outcomes by ensuring a more thorough and accurate removal of lymph nodes, as a result it is critical for preventing cancer spread.

Dr. Xiaofeng Yang, the principal investigator of the study, highlighted the transformative nature of the new technique: "Integrating ICG and fluorescent imaging into bladder cancer surgery is a game-changer. It is crucial for preventing cancer recurrence for unparalleled precision in locating and excising pelvic lymph nodes. Not only does this approach optimize the surgical process, but it also has the potential to enhance survival rates by ensuring more complete lymph node dissection. Our findings underscore the importance of ongoing innovation in surgical oncology to improve patient care."

The introduction of this fluorescent imaging technique holds immense promise for the future of bladder cancer treatment. By improving the accuracy and efficiency of PLND, this method could significantly reduce surgical complications and improve long-term patient outcomes. It may become a standard practice in RC, elevating the overall quality of care. Additionally, the enhanced visualization of lymphatic pathways could provide a deeper understanding of tumor metastasis, driving future research and treatment strategies. The potential for this technique to be adapted for use in other cancers further highlights its transformative impact on the field of surgical oncology.