Fluorescence-guided surgery for esophageal and gastric tumors

Fluorescence guidance has three major applications in oncological surgery of the foregut: tumor identification, lymph node (LN) mapping, and perfusion assessment. Vital dyes such as indocyanine green (ICG) have been demonstrated to be cheap; safe; easy to use; and highly effective in tumor identification, sentinel LN (SLN) mapping, and anastomotic perfusion assessment. This chapter investigates the specific use of ICG-based fluorescence-guided imaging in the identification of esophageal and gastric tumors, anastomotic perfusion assessment postgastrectomy and postesophagectomy, and finally the technique of SLN mapping in oncologic lymphadenectomy. The current body of clinical research and application of fluorescence guidance in the foregut oncologic surgery are predominantly based on feasibility studies and retrospective data, and further studies (randomized controlled) demonstrating the benefits of ICG use as standard-of-care in surgical management of esophageal cancer and gastric cancer are needed to encourage widespread adoption.