# Fluorescence Guided Surgery in Gastric Cancer: What Do We Have and What Can We Do?

## TL;DR

This review explores how fluorescence imaging can improve gastric cancer surgery by helping surgeons locate tumors and lymph nodes more precisely, but highlights the need for standardized protocols.

## Contribution

The paper systematically reviews current fluorescence-guided surgery practices in gastric cancer and identifies gaps in standardization and evidence.

## Key findings

- Fluorescence-guided imaging improves tumor localization and lymph node yield in gastric cancer surgery.
- There is no consensus on optimal indocyanine green (ICG) dosage or administration methods.
- Current evidence supports fluorescence imaging safety and efficacy, but standardized protocols are needed.

## Abstract

Fluorescence imaging has emerged as a valuable adjunct in gastric surgery, enhancing resection precision and oncologic outcomes. However, the use of indocyanine green (ICG) remains controversial due to uncertainties in efficacy and administration. A lack of standardized protocols persists. This review summarizes current applications of fluorescence in gastric cancer surgery, outlining existing challenges and future research needs.

A systematic PubMed search (2004–2024) was conducted using keywords such as “indocyanine green,” “carbon particle,” “blue dye,” “gastric cancer,” and “gastroesophageal junction cancer” to identify and review key uses of fluorescence agents in gastrointestinal malignancies.

Fluorescence‐guided imaging aids intraoperative tumor localization, shortens operative time, and enhances lymph node (LN) yield, improving staging accuracy. Its role in sentinel lymph node (SLN) detection is still under debate due to false negatives. ICG fluorescence angiography (ICG‐FA) may lower anastomotic leak rates, though strong supporting evidence is limited. No consensus exists regarding ICG dosage, timing, or delivery method.

Current evidence supports the safety and efficacy of fluorescence imaging in gastrointestinal surgery, with promising outcomes in precision and staging. However, uniform protocols for fluorescence use are urgently needed. Future studies should aim to standardize administration and optimize clinical implementation to fully realize its benefits.

This review explores the current applications of fluorescence‐guided surgery in gastric cancer, focusing on tracers such as indocyanine green (ICG), blue dyes, and carbon particles. It highlights their roles in tumor localization, lymph node mapping, and perfusion assessment, while emphasizing the need for standardized protocols to optimize surgical precision and outcomes.