ReviewSurgical endoscopy2026
Indocyanine green-guided lymphadenectomy and survival of patients with gastric cancer: a systematic review and meta-analysis of time-to-event data.
Review in Surgical endoscopy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Authors and funding
5 authors.
Funding
Abstract
backgroundIndocyanine 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.
methodsPubMed, 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.
resultsSeven 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).
conclusionICG-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.
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