Background: Fluorescence imaging using indocyanine green in thoracic and esophageal surgery is gaining popularity because of the potential to facilitate surgical planning, disease staging, and reduce postoperative complications. To optimize use of fluorescence imaging in thoracic and esophagealsurgery, an expert panel sought to establish a set of recommendations at a consensus meeting.
Methods: The panel included 12 experts in thoracic and/or upper gastrointestinal surgery from Asia Pacific countries. Prior to meeting, seven focus areas were defined: i) intersegmental plane identification for sublobar resections ii) pulmonary nodule localization; iii) lung tumor detection; iv) bullous lesion detection; v) lymphatic mapping of lung tumors; vi) evaluation of gastric conduit perfusion; and vii) lymphatic mapping in esophageal surgery. A literature search of the PubMed database was conducted using keywords ‘indocyanine green’, ‘fluorescence’, ‘thoracic’, ‘surgery’ and ‘esophagectomy’. At the meeting, panelists addressed each focus area by discussing the most relevant evidence and their clinical experiences. Consensus statements were derived from the proceedings, followed by further discussions, revisions, finalization and unanimous agreement. Each statement was assigned a level of evidence and a grade of recommendation.
Results: A total of nine consensus recommendations were established. Identification of the intersegmental plane for sublobar resections, localization of pulmonary nodules, lymphatic mapping in lung tumors, and assessment of gastric conduit perfusion were applications of fluorescence imaging that have the most robust current evidence.
Conclusions: Based on best available evidence and expert opinions, these consensus recommendations may facilitate thoracic and esophageal surgery using fluorescence imaging.