Fluorescence Lymph Node Mapping Using ICG Improves Lateral Lymph Node Dissection for Mid-Low Rectal Cancer: A Propensity Score-Matched Cohort

Fluorescence Lymph Node Mapping Using ICG Improves Lateral Lymph Node Dissection for Mid-Low Rectal Cancer: A Propensity Score-Matched Cohort | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Fluorescence Lymph Node Mapping Using ICG Improves Lateral Lymph Node Dissection for Mid-Low Rectal Cancer: A Propensity Score-Matched Cohort Wenlong Qiu, Gang Hu, Shiwen Mei, Yuegang Li, Yuhan Wang, Huiyong Niu, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5265259/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 13 Jul, 2025 Read the published version in Techniques in Coloproctology → Version 1 posted 6 You are reading this latest preprint version Abstract Background: Patients with lateral lymph node metastasis (LLNM) present particular challenges for both diagnosis and treatment. This study aimed to assess whether indocyanine green (ICG) assisted lymph node mapping with near-infrared imaging (NIRI) enhances the effectiveness of lateral lymph node dissection (LLND) by further categorizing the lateral lymph nodes in patients with mid-low rectal cancer. Methods: Submucosal indocyanine green injection was performed on the distal margin of the rectal cancer. In the ICG-LLND group, the lymphatic drainage pathway and distribution of lateral lymph nodes (LLNs) were explored using a laparoscopic NIRI system. Pathological evaluations were conducted for both the ICG-LLND group and the control group. Results: The ICG-LLND group demonstrated a significantly shorter postoperative hospital stay compared to the control group, both before (P<0.001) and after (P=0.001) matching. While blood loss and operating time were similar between groups, the ICG-LLND group had fewer cases of anastomotic leakage (P=0.206). Postoperative lymph node harvesting was significantly higher in the ICG-LLND group, with more total lymph nodes (P=0.001) and lateral lymph nodes (P=0.002) harvested. The number of harvested lymph nodes in the obturator and internal iliac regions was also higher in the ICG-LLND group (P=0.001), and the number of positive lymph nodes in these regions was significantly greater before (P=0.027) and after (P=0.013) matching. Univariate and multivariate analyses showed that ICG-LLND, nCRT, and positive pN stage were associated with increased lymph node harvest. Conclusions: ICG-LLND improved lateral lymph node harvest, particularly obturator lymph nodes, and shortened postoperative hospital stay without increasing complications. This technique may enhance surgical outcomes in patients requiring lymph node dissection. rectal cancer lateral lymph node indocyanine green fluorescence-guide lymph node mapping propensity score matching Figures Figure 1 Figure 2 Introduction Complete resection of the primary tumor and its associated lymph nodes is crucial for effectively treating rectal cancer. The number of lymph nodes retrieved plays a significant role in determining long-term oncological outcomes in advanced colorectal cancer. Total mesorectal excision (TME) remains the standard surgical approach for this condition.[ 1 ]. Patients with advanced lower rectal cancer, especially those with tumors at or below the peritoneal reflection, sometimes develop metastases to the lateral lymph nodes (LLNs). These nodes are a significant site for postoperative local recurrence[ 2 , 3 ]. Diagnosing and treating patients with LLN metastasis (LLNM) present considerable challenges. The surgical risks and potential morbidity associated with lateral lymph node dissection (LLND), coupled with uncertain oncological outcomes, have made LLND a contentious and less frequently performed procedure, particularly when pathological findings in the lateral lymph nodes are negative[ 4 , 5 ]. Preoperative radiological examinations have detected LLNM in 14–20% of cases with locally advanced low rectal cancer during the initial assessment. However, these methods remain insufficient, and some instances of LLNM go undetected.[ 6 ]. Lateral lymph node dissection (LLND) presents significant technical challenges and is often debated due to the difficulty in distinguishing lateral lymph nodes from actual lymphatic pathways originating from the primary tumor during surgery. This complexity makes it tough to ensure that the correct regions are targeted and that the dissection is complete. Achieving precise identification and comprehensive removal of metastatic lateral lymph nodes (LLNs) during surgery could potentially enhance survival rates for patients with advanced rectal cancer. Consequently, an intraoperative visual technique that facilitates easy identification of LLNs and their lymphatic drainage pathways is crucial for surgeons to achieve optimal oncological outcomes[ 7 ]. Indocyanine green (ICG) assisted LLND with near-infrared imaging (NIRI) emerges as a promising approach. The recent advancements in NIRI systems for minimally invasive surgery have led to increased utilization of fluorescence imaging in colorectal procedures[ 8 – 10 ]. When injected into peritumoral areas, ICG disseminates through the lymphatic system and attaches to macrophages within the lymph nodes. NIRI system facilitates real-time visualization of lymph nodes and their drainage pathways during surgery[ 11 ]. Although some studies have explored the use of indocyanine green (ICG) for lateral lymph node dissection (LLND) in rectal cancer[ 12 – 14 ], more evidence is needed to define its impact on the number of harvested lateral lymph nodes and specific subgroups. The utility of ICG in lateral lymph node dissection remains debated, with current analyses considering the lateral lymph nodes collectively. No studies have subdivided the lateral lymph nodes to evaluate the specific application value of ICG NIRI in these subgroups. This study aimed to determine whether grouping LLNs could enhance the effectiveness of ICG NIRI in LLND. Methods Patients We enrolled 223 patients who underwent laparoscopy-assisted TME and LLND for mid and low adenocarcinoma of the rectum between January 2018 and December 2023 at the Cancer Hospital, Chinese Academy of Medical Sciences, and Peking Union Medical College in China (Fig. 1 ). This study was approved by the Ethics Committee of the Clinical Trials Center of the National Cancer Center. All participants provided written informed consent, which was obtained prior to their participation in the study, and permission from the ethics committee was granted to conduct the research. The inclusion criteria were patients with adenocarcinoma of the rectum, aged over 18 years. The exclusion criteria included patients under 18 years of age (n = 1), those diagnosed with a pathology other than adenocarcinoma, such as adenoma or adenocarcinoma in situ (n = 3), those who underwent combined resection of other organs (n = 2) or emergency surgery (n = 2), and those with distant metastasis at the time of first diagnosis (n = 4). Fluorescence-guided lymph nodes dissection The Pelvic or rectal magnetic resonance imaging (MRI) is crucial for diagnosing lateral lymph node metastasis. LLNM in mid-low rectal cancer was primarily diagnosed based on the short axis of lymph nodes ≥ 7 mm at the time of initial diagnosis. This criterion was supplemented by the assessment of malignant imaging features and clinical-pathological high-risk factors. In cases where the short axis of the lymph nodes was < 7 mm but two or more malignant imaging characteristics were present, clinical diagnosis of positive lymph nodes was considered. Fluorescence-guided lymph node dissection enhanced lymph node mapping in rectal cancer through ICG endoscopic tattooing. A total of 0.25 ml of ICG (2.5 mg/ml) was injected submucosally at four sites around the tumor to optimize lymphatic drainage. Administered one hour before surgery, ICG improved tumor visibility with laparoscopic NIR camera. This study builds on the previously described fluorescence-assisted lateral lymph node dissection technique[ 15 ] and facilitated identification of fluorescent lymph nodes, including internal iliac (station 263), obturator (station 283), external iliac (station 293), and common iliac (station 273) nodes. During lateral lymph node dissection, the primary focus is on the obturator (station 283) and internal iliac (station 263) nodes, as these are the most common sites of metastasis in rectal cancer. In some patients, dissection may also extend to the external iliac (station 293) and common iliac (station 273) lymph nodes, depending on the extent of the disease and the surgical strategy. This approach ensures thorough clearance of regional lymph nodes, helping to reduce the risk of recurrence. Procedures were conducted by skilled surgeons using a standard 5-port laparoscopic technique, focusing on key dissection areas to preserve autonomic nerves linked to pelvic lymph node metastasis. Dissection began with careful preservation of the ureteric hypogastric fascia and hypogastric nerve, accessing obturator lymph nodes while protecting critical vessels and nerves. This approach ensured complete preservation of autonomic nerve function. Pathologic evaluation After completing the surgical procedure, the specimen was extracted through a mini-laparotomy incision. In the ICG-LLND group, the surgeon harvested fluorescent lymph nodes using a laparoscopic NIR camera for guidance, labeling them by anatomical location. In the control group, excised tissue was placed on an auxiliary table, and lymph nodes near the ligation sites were examined and dissected without fluorescence imaging. Lateral lymph nodes are classified into several key stations based on their location relative to major pelvic arteries. Station 263 refers to the internal iliac lymph nodes, which are critical in rectal cancer metastasis. Station 283 includes the obturator lymph nodes, another common site of lateral metastasis. Station 293 represents the external iliac lymph nodes, which are occasionally involved in the spread of rectal cancer. Station 273 corresponds to the common iliac lymph nodes, which may be included in certain cases of extensive metastasis. Pathological assessments were conducted separately for fluorescent and non-fluorescent LLNs, with hematoxylin and eosin staining performed to identify metastatic lymph nodes. The pathologist counted the harvested and metastatic lymph nodes in the three designated regions. Clinical Outcomes The effectiveness of ICG NIRI in LLND during laparoscopic TME was evaluated by comparing harvested and metastatic lymph node counts between ICG-LLND and control groups, focusing on LLNs. In the ICG-LLND group, lymphatic drainage routes were analyzed, and metastatic lymph node locations were compared with these pathways. Additionally, factors influencing the number of harvested and metastatic lymph nodes in patients undergoing laparoscopy-assisted TME with LLND were identified. Statistical Analysis Statistical analyses were performed to compare outcomes between the ICG-LLND group and conventional group (control group) focusing on harvested and metastatic lymph node counts, and the detection rate of metastatic lateral lymph nodes. The Student's t-test compared mean lymph node counts, while Pearson’s Chi-square and Fisher’s exact tests assessed categorical variables related to detection rates. To control for potential confounding variables, propensity score matching (PSM) was applied to achieve balanced baseline characteristics between the ICG-LLND and control groups. Propensity scores were calculated using logistic regression, incorporating clinically relevant variables. After matching, the baseline characteristics between the two groups were assessed for balance, with all P values greater than 0.05 and standardized mean differences (SMD) around 0.1. Simple linear regression identified clinicopathologic variables linked to lymph node counts, and multivariable linear regression evaluated factors associated with these counts. Analyses were conducted using SPSS 27.0 and R 4.3.0, with statistical significance set at p < 0.05. Results Patients The clinicopathological characteristics of the patients were comparable between the ICG-LLND and control groups, as presented in Table 1 . No adverse events were associated with the submucosal ICG injection. The optimal ICG-LLND protocol demonstrated a high success rate of 98.3%. There was one instance of ICG-LLND failure involving a female patient with a high body mass index (BMI) and thick mesenteric fat tissue, which compromised fluorescent lymphatic drainage. Table 1 The basic characteristics of patients before and after PSM. Before PSM After PSM Clinical variables Control n = 156 (%) ICG-LLND, n = 67 (%) P Control, n = 51 (%) ICG-LLND, n = 51(%) P SMD Age, yr mean ± SD 56.9 ± 11.2 57.9 ± 11.7 0.518 57.2 ± 11.6 58.8 ± 12.7 0.816 < 60 84 (53.8) 35 (52.2) 0.825 28 (54.9) 27 (52.9) 1.000 0.119 ≥ 60 72 (46.2) 32 (47.8) 23 (45.1) 24 (47.1) Sex male 61 (39.1) 31 (46.3) 0.319 24 (47.1) 21 (41.2) 0.550 0.150 female 95 (60.9) 36 (53.7) 27 (52.9) 30(58.8) BMI (kg/m2) mean ± SD 24.4 ± 3.1 24.3 ± 3.4 0.913 24.2 ± 3.2 23.5 ± 3.9 0.562 < 24 72 (46.2) 26 (38.8) 0.311 27 (52.9) 26 (51.0) 0.854 0.081 ≥ 24 84 (53.8) 41 (61.2) 24 (47.1) 25 (49.0) cT status cT 1–2 23 (14.7) 23 (34.3) 0.001 10 (19.6) 13 (25.5) 0.636 0.140 cT 3–4 133 (85.3) 44 (65.7) 41 (80.4) 38 (74.5) cN status cN 0 44 (28.2) 31 (46.3) 0.009 20 (39.2) 22 (43.1) 0.841 0.080 cN 1–2 112 (71.8) 36 (53.7) 31 (60.8) 29 (56.9) pT status pT 1–2 46 (29.5) 34 (50.7) 0.002 21 (41.2) 22 (43.1) 1.000 0.076 pT 3–4 110 (70.5) 33 (49.3) 30 (58.8) 29 (56.9) pN status pN 0 53 (34.0) 33 (49.3) 0.032 22 (43.1) 24 (47.1) 0.842 0.079 pN 1–2 103 (66.0) 34 (50.7) 29 (56.9) 27 (52.9) Pathologic stage I-II 54 (34.6) 33 (49.3) 0.057 22 (43.1) 24 (47.1) 0.842 0.085 III-IV 102 (65.4) 34 (5.7) 29 (56.9) 27 (52.9) Tumor size (cm) mean ± SD 4.0 ± 1.8 4.0 ± 1.6 0.931 3.9 ± 1.4 4.0 ± 1.7 0.512 ≤ 4.0 95 (60.9) 39 (58.2) 0.707 32 (62.7) 30 (58.8) 0.839 0.080 > 4.0 61 (39.1) 28 (41.8) 19 (37.3) 21 (41.2) nCRT Yes 61 (39.1) 37 (55.2) 0.026 22 (43.1) 24 (47.1) 0.842 0.079 No 95 (60.9) 30 (45.8) 29 (56.9) 27 (52.9) Differentiation Well/moderate 98 (62.8) 37 (55.2) 0.287 27 (52.9) 29 (56.9) 0.842 0.078 Poorly 58 (37.2) 30 (44.8) 24 (47.1) 22 (43.1) Lymphatic invasion Negative 92 (59.0) 41 (61.2) 0.757 34 (66.7) 32 (62.7) 0.836 0.082 Positive 64 (41.0) 26 (38.8) 17 (33.3) 19 (37.3) Vascular invasion Negative 96 (61.5) 51 (76.1) 0.035 40 (78.4) 37 (72.5) 0.645 0.137 Positive 60 (38.5) 16 (23.9) 11 (21.6) 14 (27.5) Perineural invasion Negative 87 (55.8) 38 (56.7) 0.896 33 (64.7) 31 (60.8) 0.838 0.081 Positive 69 (44.2) 29 (43.3) 18 (35.3) 20 (39.2) Note: ICG-LLND: Indocyanine Green Lymph Node Detection; PSM: Propensity Score Matching; Control: The standard procedure group without ICG lymph node detection; ICG-LLND: The group using indocyanine green for lymph node detection; BMI: Body Mass Index; cT: Clinical Tumor stage; cN: Clinical Node stage; pT: Pathologic Tumor stage; pN: Pathologic Node stage; SMD: Standardized Mean Difference; nCRT: Neoadjuvant Chemotherapy; Median (Range): The median number of nodes with the range in parentheses; pT, pN, cT, and cN stages refer to the classifications of tumor and node involvement based on pathological and clinical evaluations. Baseline characteristics of the primary cohort indicated that patients who underwent ICG-LLND had higher rates of tumor stage (P = 0.002), nodal stage (P = 0.032), nCRT (P = 0.026), and vascular invasion (P = 0.035). After PSM, these baseline characteristics were well balanced (Table 1 and Fig. 1 ). Postoperative outcomes and complications comparison The postoperative outcomes showed key differences between the control and ICG-LLND groups. Before matching, the ICG-LLND group had a shorter hospital stay (6 vs. 7 days, P < 0.001), and after matching, it was also shorter (5 vs. 6 days, P = 0.001). Blood loss was lower in the ICG-LLND group, though not significantly (30 vs. 50 ml, P = 0.185 before matching; 20 vs. 50 ml, P = 0.422 after matching). Operating time was similar (P = 0.305 before, P = 0.937 after matching). The ICG-LLND group had fewer anastomotic leakage cases (1 vs. 6 before matching, 1 vs. 2 after matching, P = 0.206). In terms of complications, six patients in the control group and one patient in the ICG-LLND group experienced postoperative anastomotic leakage, and two patients in the control group had postoperative anastomotic bleeding. Postoperative lymph node harvesting and dissection outcomes between ICG-LLND group and control group The median number of total harvested lymph nodes was significantly higher in the ICG-LLND group compared to the control group (31 vs. 26, P = 0.001), as well as the number of harvested lateral lymph nodes (LLNs) (11 vs. 7, P = 0.002) (Table 2 ). However, there was no significant difference in the number of positive total lymph nodes (3 vs. 5, P = 0.409) or positive LLNs (1 vs. 2, P = 0.142) between the two groups. After propensity score matching (PSM), the ICG-LLND group continued to show a significantly higher number of harvested total lymph nodes (32 vs. 25, P = 0.001) and harvested LLNs (8 vs. 6, P = 0.008) compared to the control group. Additionally, the postoperative hospital stay was significantly shorter in the ICG-LLND group (5 vs. 6 days, P = 0.001). Regarding specific lymph node stations, the median number of harvested station 283 nodes was significantly higher in the ICG-LLND group compared to the control group (6 vs. 4, P = 0.001). The number of positive station 283 nodes was also higher in the ICG-LLND group before (2 vs. 1, P = 0.027) after PSM (2 vs. 1, P = 0.013). No significant differences were observed in the number of harvested station 263 (3 vs. 3, P = 0.119), station 273 (4 vs. 4, P = 0.056), or station 293 (3 vs. 3, P = 0.609) lymph nodes between the two groups before or after PSM (Table 3 ). The lateral lymph node dissection (LLND) outcomes for both groups are shown in Fig. 2 . Table 2 Postoperative lymph node results in mid-low rectal cancer patients before (n = 223) and after (n = 102) PSM Before match After match Control (n = 156) ICG-LLND (n = 67) P Control (n = 51) ICG-LLND (n = 51) P Number of harvested total nodes, median (range) 26 (6,69) 31 (11,61) 0.001 25 (11,58) 32 (14,80) 0.001 Number of positive harvested total nodes, median (range) 5 (1,24) 3 (1,28) 0.409 2 (1,11) 3 (1,15) 0.731 Number of harvested lateral lymph nodes, median (range) 7 (1,29) 11 (1,31) 0.002 6 (1,23) 8 (1,25) 0.008 Number of positive lateral lymph nodes, median (range) 2 (1,8) 1 (1,10) 0.142 1 (1,3) 1 (1,10) 0.254 Number of harvested station 283 nodes, median (range) 4 (1,13) 6 (1,21) 0.001 3 (1,9) 5 (1,14) 0.012 Number of positive station 283 nodes, median (range) 1 (1,2) 2 (1,6) 0.027 1 (1,2) 2 (1,4) 0.013 Number of harvested station 263 nodes, median (range) 3 (1,14) 3 (1,15) 0.119 2 (1,8) 3 (1,8) 0.157 Number of positive station 263 nodes, median (range) 1 (1,16) 1 (1,5) 0.260 1 (1,2) 1 (1,3) 0.170 Number of harvested station 293 nodes, median (range) 3 (1,9) 3 (1,10) 0.609 1 (1,1) 1 (1,1) 0.673 Number of positive station 293 nodes, median (range) 1 (1,3) 1 (1,4) 0.435 1 (1,3) 1 (1,3) 0.417 Number of harvested station 273 nodes, median (range) 2 (1,9) 4 (1,13) 0.056 3 (1,9) 5 (1,13) 0.539 Number of positive station 273 nodes, median (range) 1 (1,2) 2 (1,3) 0.490 1 (1,1) 1 (1,1) 0.945 Note: ICG-LLND: Indocyanine Green Lymph Node Detection; PSM: Propensity Score Matching; Control: The standard procedure group without ICG lymph node detection; ICG-LLND: The group using indocyanine green for lymph node detection; Median (Range): The median number of nodes with the range in parentheses. Table 3 Postoperative outcomes and complications in patients before (n = 223) and after (n = 102) PSM Before match After match Control (n = 156) ICG-LLND (n = 67) P Control (n = 51) ICG-LLND (n = 51) P Postoperative hospital stay (day), median (range) 7 (3,47) 6 (2,19) < 0.001 6 (3,12) 5 (2,8) 0.001 Estimated blood loss (ml), median (range) 50 (5,600) 30 (5,600) 0.185 50 (5,700) 20 (5,400) 0.422 Operating time (min), median (range) 250 (76,689) 246 (127,527) 0.305 24 (75,486) 247 (88, 485) 0.937 Complications 0.206 1 intraoperative bleeding 2 0 0 0 anastomotic leakage 6 1 2 1 ileus 0 0 0 0 incisional infection 0 0 0 0 Note: ICG-LLND: Indocyanine Green Lymph Node Detection; PSM: Propensity Score Matching; Control: The standard procedure group without ICG lymph node detection; ICG-LLND: The group using indocyanine green for lymph node detection; Median (Range): The median number of nodes with the range in parentheses. Table 4 The univariate and multivariate analysis of risk factors for harvested lateral lymph nodes Clinicopathological variables Univariate analysis Multivariate analysis Beta 95% CI P Beta 95% CI P Age -0.104 -0.139, 0.016 0.120 Sex -0.024 -2.117, 1.463 0.719 BMI 0.010 -0.260, 0.302 0.883 nCRT 0.223 1.261, 4.724 0.001 0.179 0.637, 4.161 0.008 pT stage -0.080 -1.246, 0.308 0.236 pN stage 0.158 0.250, 2.650 0.018 -0.071 -1.883, 0.573 0.294 Differentiation -0.064 -2.666, 0.934 0.344 Lymphatic invasion -0.105 -3.207, 0.367 0.119 Vascular invasion -0.075 -2.904, 0.805 0.266 Perineural invasion -0.099 -3.090, 0.446 0.142 ICG-LLND 0.224 1.376, 5.125 0.001 0.180 0.712, 4.521 0.007 Note: the pN stage was classified without the status of lateral lymph nodes; nCRT, neoadjuvant chemotherapy. Univariate and Multivariate Analysis of NIRI for LLND Lymph node count was associated with various clinicopathological variables. In the simple linear regression model (Table 5 ), the ICG-LLND (Beta = 0.224, 95% CI = 1.376–5.125, P = 0.001) and positive pN stage (Beta = 0.158, 95% CI = 0.250–2.650, P = 0.018) had an impact that increased the harvested LLNs count. In the multivariable linear regression analysis, nCRT (Beta = 0.179, 95% CI = 0.637–4.161, P = 0.008) and ICG-LLND (Beta = 0.180, 95% CI = 0.712–4.521, P = 0.007) was confirmed as independent associated factors that could increase the harvested lymph node count. Table 5 The univariate and multivariate analysis of risk factors for metastatic lateral lymph nodes Clinicopathological variables Univariate analysis Multivariate analysis Beta 95% CI P Beta 95% CI P Age -0.002 -0.016, 0.016 0.977 Sex -0.063 -0.541, 0.193 0.351 BMI -0.075 -0.090, 0.025 0.265 nCRT 0.412 0.234, 0.725 0.002 0.124 -0.034, 0.716 0.075 pT stage 0.184 0.064, 0.379 0.006 0.047 -0.100, 0.214 0.476 pN stage 0.355 0.435, 0.901 < 0.001 0.163 0.025,0.590 0.033 Differentiation 0.210 0.225, 0.949 0.002 0.082 -0.136,0.594 0.218 Lymphatic invasion 0.347 0.620, 1.312 < 0.001 0.190 0.079, 0.976 0.021 Vascular invasion 0.331 0.594, 1.315 < 0.001 0.145 -0.030,0.863 0.067 Perineural invasion 0.292 0.455, 1.152 < 0.001 0.059 -0.263,0.586 0.454 ICG-LLND -0.099 -0.687, 0.099 0.142 Note: the pN stage was classified without the status of lateral lymph nodes; nCRT, neoadjuvant chemotherapy. The risk factors for lateral nodal metastasis were also analyzed (Table 6). Pathological T3-4 stage (P = 0.006), positive pN stage except for LLNs (P < 0.001), underwent nCRT (P = 0.002), poor differentiation level (P = 0.002), and lymphatic, vascular (P < 0.001), or perineural invasion (P < 0.001) were associated with positive LLNs. In the multivariable linear regression analysis, the lymphatic invasion (Beta = 0.190, 95% CI = 0.079, 0.976, P = 0.021) and positive pN stage except for LLNs (Beta = 0.163, 95% CI = 0.025–0.590, P = 0.033) was an independent risk factor for LLNs metastasis. Discussion The LLNs recurrence remains one of the primary causes of local treatment failure following radical surgery for locally advanced rectal cancer[ 16 , 17 ]. Although routine LLND can effectively remove potential metastatic lymph nodes, its impact on overall patient survival remains a topic of debate[ 18 – 20 ]. This controversy stems largely from the limitations of current diagnostic techniques in accurately identifying LLNM, which can result in either incomplete or excessive dissection, both of which may negatively influence patient outcomes. Moreover, the metastatic potential of different LLN groups is not yet fully understood. Thus, improving the precision of intraoperative identification of LLNs is critical for reducing surgical complications and improving oncological outcomes. In this study, we retrospectively analyzed 223 patients who underwent TME and LLND. The risk of LLNM was assessed for each patient group, and the role of ICG NIRI as a surgical navigation tool was evaluated. LLNM in rectal cancer is predominantly found in the internal iliac nodes and obturator nodes, which are key anatomical regions for dissection. Our findings demonstrated that ICG NIRI significantly increased the number of harvested lymph nodes, particularly LLNs. In multivariate analysis, ICG-LLND was identified as independent factors that increased the total number of harvested LLNs. However, consistent with previous studies, the uses of ICG NIRI did not result in an increase in the number of positive lymph nodes[ 13 ]. The technique was particularly effective in increasing both the total and positive number of obturator lymph nodes retrieved, although no significant improvement was observed for internal iliac nodes. This result may be closely related to the properties of the ICG fluorescent dye. ICG fluorescence primarily detects normal lymph nodes that drain from the tumor surrounding area, while the imaging efficacy of ICG fluorescence is poor for regions that have been invaded by cancer tissue, which may lead to weakened or absent fluorescence signals. Specifically, ICG fluorescence is effective in distinguishing normal lymph nodes but has limited effectiveness when it comes to identifying lymph nodes invaded by tumors [ 21 ]. This finding is particularly important for the development of near-infrared fluorescence-based surgical navigation strategies, suggesting that when using ICG fluorescence for surgical navigation, it may be necessary to combine it with other techniques or markers to more effectively identify lymph nodes that have been invaded by tumors. The advantage of ICG-LLND lies in its real-time navigation capability, enabling surgeons to accurately locate and excise LLNs during surgery. The strong affinity of ICG for the lymphatic system facilitates rapid and precise visualization of lymph nodes, thereby enhancing detection sensitivity[ 22 – 24 ]. Additionally, the ICG NIRI assists in identifying smaller or occult metastatic lymph nodes, reducing the risk of missed detections while also minimizing unnecessary dissection, which can improve overall surgical outcomes[ 25 , 26 ]. Anatomically, obturator lymph nodes are located on the external surface of the bladder's hypogastric fascia and are surrounded by a relatively complete fascial capsule, making them more straightforward to dissect. In contrast, internal iliac lymph nodes are often positioned near critical vascular structures such as the inferior vesical and internal pudendal arteries, which complicates complete excision[ 27 ]. The ICG NIRI is highly effective in identifying and dissecting obturator lymph nodes but proves less helpful for internal iliac lymph nodes, especially those located behind blood vessels. To ensure complete lymph node dissection, thorough exposure of the internal iliac artery and its branches, combined with adherence to fascia-oriented surgical techniques, is essential. Ongoing advancements in ICG NIRI technology, including the development of more specific fluorescent probes, are needed to improve the visualization of deeper or hidden lymph nodes. Importantly, no significant differences in postoperative complications—including intraoperative bleeding, anastomotic leakage, ileus, and incisional infection—were observed between the ICG-LLND and control groups. This suggests that ICG NIRI does not contribute to overtreatment in the short term. The precision of ICG NIRI likely contributed to reduced surgical trauma, minimized unnecessary tissue dissection, and enhanced operative efficiency, which may explain the shorter postoperative hospital stays observed in the ICG-LLND group. By improving surgical accuracy, ICG NIRI may also reduce the incidence of postoperative complications such as lymphatic leakage and infection, thereby accelerating patient recovery. Despite these promising short-term benefits, the potential risk of overtreatment with ICG NIRI cannot be entirely ruled out, particularly if unnecessary lymph node dissection results in long-term complications. However, no evidence of overtreatment was observed in this study. To comprehensively assess the long-term impact of ICG NIRI, including oncological outcomes such as overall survival and disease-free survival, further follow-up is required. Limitations of this study include its retrospective design, which may introduce selection bias despite the use of propensity score matching. Additionally, the impact of preoperative neoadjuvant therapies, such as radiation, on lymph node harvest was not fully explored and should be further investigated. Another limitation of ICG NIRI was its reduced efficacy in identifying deeper or hidden lymph nodes, particularly around the internal iliac vessels, which underscores the need for improved visualization techniques and more specific fluorescent probes. Further prospective studies are required to address these limitations and refine the use of ICG NIRI in surgical practice. In conclusion, the ICG NIRI shows promise as a strategy to enhance the accuracy of LLND in rectal cancer surgery. It significantly increases lymph node harvest while reducing postoperative hospital stays without raising the risk of short-term complications. However, careful evaluation of long-term outcomes and potential overtreatment risks is necessary. Future prospective studies are essential to fully understand the long-term implications and to further optimize ICG NIRI technology. Declarations Funding: This research was funded by the National Key Research and Development Program (No. 2022YFC2505003), CAMS Innovation Fund for Medical Sciences (No. 2022-12M-C&T-B-057), National Natural Science Foundation of Beijing Municipality (No. 4232058) Conflict of interest: The authors declare no conflict of interest. Ethical approval and consent to participate: Ethics reference number is NCC2024C-793, which is approved by Ethics Committee of the Clinical Trials Center of National Cancer Center (Phone + 0086 010 87787112). All participants gave their written informed consent to participate in this study. Consent for publication: Not applicable. Data availability: The datasets generated and/or analyzed during the current study are not publicly available due to privacy and confidentiality concerns but are available from the corresponding author on reasonable request. Availability of data and materials: Data and materials related to this study are available from the corresponding author upon reasonable request. Restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. However, access may be granted by the authors on a case by-case basis. References Knol J, Keller DS Total Mesorectal Excision Technique-Past, Present, and Future. Clin Colon Rectal Surg 33 : 134-143 Williamson JS, Quyn AJ, Sagar PM Rectal cancer lateral pelvic sidewall lymph nodes: a review of controv ersies and management. Br J Surg 107 : 1562-1569 Sammour T, Bedrikovetski S Radiomics for Diagnosing Lateral Pelvic Lymph Nodes in Rectal Cancer: Artificial Intelligence Enabling Precision Medicine? Ann Surg Oncol 27 : 4082-4083 Otero de Pablos J, Mayol J Controversies in the Management of Lateral Pelvic Lymph Nodes in Patie nts With Advanced Rectal Cancer: East or West? Front Surg 6 : 79 Schaap DP, Boogerd LSF, Konishi T, Cunningham C, Ogura A, Garcia-Aguilar J, Beets GL, Suzuki C, Toda S, Lee IK, Sammour T, Uehara K, Lee P, Tuynman JB, van de Velde CJH, Rutten HJT, Kusters M, Lateral Node Study C Rectal cancer lateral lymph nodes: multicentre study of the impact of obturator and internal iliac nodes on oncological outcomes. Br J Surg 108 : 205-213 Amano K, Fukuchi M, Kumamoto K, Hatano S, Ohno H, Osada H, Ishibashi K, Ishida H Pre-operative Evaluation of Lateral Pelvic Lymph Node Metastasis in Lo wer Rectal Cancer: Comparison of Three Different Imaging Modalities. J Anus Rectum Colon 4 : 34-40 Son GM, Yun MS, Lee IY, Im SB, Kim KH, Park SB, Kim TU, Shin D-H, Nazir AM, Ha GW Clinical Effectiveness of Fluorescence Lymph Node Mapping Using ICG fo r Laparoscopic Right Hemicolectomy: A Prospective Case-Control Study. Cancers (Basel) 15 : 4927 Currie AC, Brigic A, Thomas-Gibson S, Suzuki N, Moorghen M, Jenkins JT, Faiz OD, Kennedy RH A pilot study to assess near infrared laparoscopy with indocyanine gre en (ICG) for intraoperative sentinel lymph node mapping in early colon cancer. Eur J Surg Oncol 43 : 2044-2051 Villegas-Tovar E, Jimenez-Lillo J, Jimenez-Valerio V, Diaz-Giron-Gidi A, Faes-Petersen R, Otero-Piñeiro A, De Lacy FB, Martinez-Portilla RJ, Lacy AM Performance of Indocyanine green for sentinel lymph node mapping and l ymph node metastasis in colorectal cancer: a diagnostic test accuracy meta-analysis. Surg Endosc 34 : 1035-1047 Liberale G, Bohlok A, Bormans A, Bouazza F, Galdon MG, El Nakadi I, Bourgeois P, Donckier V Indocyanine green fluorescence imaging for sentinel lymph node detecti on in colorectal cancer: A systematic review. Eur J Surg Oncol 44 : 1301-1306 Bahmani B, Gupta S, Upadhyayula S, Vullev VI, Anvari B Effect of polyethylene glycol coatings on uptake of indocyanine green loaded nanocapsules by human spleen macrophages in vitro. J Biomed Opt 16 : 051303 Su H, Xu Z, Bao M, Luo S, Liang J, Pei W, Guan X, Liu Z, Jiang Z, Zhang M, Zhao Z, Jin W, Zhou H Lateral pelvic sentinel lymph node biopsy using indocyanine green fluo rescence navigation: can it be a powerful supplement tool for predicti ng the status of lateral pelvic lymph nodes in advanced lower rectal c ancer. Surg Endosc 37 : 4088-4096 Tang B, Zhou S, He K, Mei S, Qiu W, Guan X, Liu F, Chi C, Wang X, Tian J, Liu Q, Tang J Applications of Near-Infrared Fluorescence Imaging and Angiography of Inferior Vesical Artery in Laparoscopic Lateral Lymph Node Dissection: A Prospective Nonrandomized Controlled Study. Dis Colon Rectum 67 : 175-184 Kehagias D, Lampropoulos C, Bellou A, Kehagias I The use of indocyanine green for lateral lymph node dissection in rect al cancer-preliminary data from an emerging procedure: a systematic re view of the literature. Tech Coloproctol 28 : 53 Tang B, Zhou S, He K, Mei S, Qiu W, Guan X, Liu F, Chi C, Wang X, Tian J, Liu Q, Tang J (2024) Applications of Near-Infrared Fluorescence Imaging and Angiography of Inferior Vesical Artery in Laparoscopic Lateral Lymph Node Dissection: A Prospective Nonrandomized Controlled Study. Dis Colon Rectum 67 : 175-184 Kim TH, Jeong S-Y, Choi DH, Kim DY, Jung KH, Moon SH, Chang HJ, Lim S-B, Choi HS, Park J-G Lateral lymph node metastasis is a major cause of locoregional recurre nce in rectal cancer treated with preoperative chemoradiotherapy and c urative resection. Ann Surg Oncol 15 : 729-737 Lee DJ-K, Sagar PM, Sadadcharam G, Tan K-Y Advances in surgical management for locally recurrent rectal cancer: H ow far have we come? World J Gastroenterol 23 : 4170-4180 Fujita S, Mizusawa J, Kanemitsu Y, Ito M, Kinugasa Y, Komori K, Ohue M, Ota M, Akazai Y, Shiozawa M, Yamaguchi T, Bandou H, Katsumata K, Murata K, Akagi Y, Takiguchi N, Saida Y, Nakamura K, Fukuda H, Akasu T, Moriya Y, Colorectal Cancer Study Group of Japan Clinical Oncology G Mesorectal Excision With or Without Lateral Lymph Node Dissection for Clinical Stage II/III Lower Rectal Cancer (JCOG0212): A Multicenter, R andomized Controlled, Noninferiority Trial. Ann Surg 266 : 201-207 Ishihara S, Kawai K, Tanaka T, Kiyomatsu T, Hata K, Nozawa H, Morikawa T, Watanabe T Oncological Outcomes of Lateral Pelvic Lymph Node Metastasis in Rectal Cancer Treated With Preoperative Chemoradiotherapy. Dis Colon Rectum 60 : 469-476 Michelassi F, Block GE Morbidity and mortality of wide pelvic lymphadenectomy for rectal aden ocarcinoma. Dis Colon Rectum 35 : 1143-1147 Sato Y, Satoyoshi T, Okita K, Kyuno D, Hamabe A, Okuya K, Nishidate T, Akizuki E, Ishii M, Yamano HO, Sugita S, Nakase H, Hasegawa T, Takemasa I (2021) Snapshots of lymphatic pathways in colorectal cancer surgery using near-infrared fluorescence, in vivo and ex vivo. Eur J Surg Oncol 47 : 3130-3136 Chen Q, Cai Y, Cheng K, Chen Z, Li J, Wu S, Peng B Real-time fluorescence-guided adhesiolysis with indocyanine green in i ntra-abdominal surgery (with video). Sci Rep 14 : 726 Chen Q-Y, Zhong Q, Liu Z-Y, Li P, Lin G-T, Zheng Q-L, Wang J-B, Lin J-X, Lu J, Cao L-L, Lin M, Tu R-H, Huang Z-N, Zeng G-R, Jiang M-C, Wang H-G, Huang X-B, Xu K-X, Li Y-F, Zheng C-H, Xie J-W, Huang C-M Indocyanine green fluorescence imaging-guided versus conventional lapa roscopic lymphadenectomy for gastric cancer: long-term outcomes of a p hase 3 randomised clinical trial. Nat Commun 14 : 7413 Wang Z, Yang X, Wang J, Liu P, Pan Y, Han C, Pei J Real-Time In Situ Navigation System With Indocyanine Green Fluo rescence for Sentinel Lymph Node Biopsy in Patients With Breast Cancer. Front Oncol 11 : 621914 Mieog JSD, Achterberg FB, Zlitni A, Hutteman M, Burggraaf J, Swijnenburg R-J, Gioux S, Vahrmeijer AL Fundamentals and developments in fluorescence-guided cancer surgery. Nat Rev Clin Oncol 19 : 9-22 Zhang Z, He K, Chi C, Hu Z, Tian J Intraoperative fluorescence molecular imaging accelerates the coming o f precision surgery in China. Eur J Nucl Med Mol Imaging 49 : 2531-2543 Shiraishi T, Sasaki T, Tsukada Y, Ikeda K, Nishizawa Y, Ito M Radiologic Factors and Areas of Local Recurrence in Locally Advanced L ower Rectal Cancer After Lateral Pelvic Lymph Node Dissection. Dis Colon Rectum 64 : 1479-1487 Table 6 Table 6 is not available with this version. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 13 Jul, 2025 Read the published version in Techniques in Coloproctology → Version 1 posted Editorial decision: Revision requested 13 Apr, 2025 Reviews received at journal 10 Apr, 2025 Reviewers agreed at journal 01 Apr, 2025 Reviewers invited by journal 30 Mar, 2025 Submission checks completed at journal 26 Mar, 2025 First submitted to journal 26 Mar, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5265259","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":436018280,"identity":"bdf2f33c-f08f-47fd-9b09-21849792a6d0","order_by":0,"name":"Wenlong Qiu","email":"","orcid":"","institution":"National Cancer Center, Chinese Academy of Medical Sciences and Peking Union Medical College","correspondingAuthor":false,"prefix":"","firstName":"Wenlong","middleName":"","lastName":"Qiu","suffix":""},{"id":436018282,"identity":"4e8ad451-bee1-4206-bdc9-2a22c8110827","order_by":1,"name":"Gang Hu","email":"","orcid":"","institution":"National Cancer Center, Chinese Academy of Medical Sciences and Peking Union Medical College","correspondingAuthor":false,"prefix":"","firstName":"Gang","middleName":"","lastName":"Hu","suffix":""},{"id":436018284,"identity":"7c2c8d3c-3f37-45ed-b944-64c7a2d3245f","order_by":2,"name":"Shiwen Mei","email":"","orcid":"","institution":"National Cancer Center, Chinese Academy of Medical Sciences and Peking Union Medical College","correspondingAuthor":false,"prefix":"","firstName":"Shiwen","middleName":"","lastName":"Mei","suffix":""},{"id":436018286,"identity":"af615059-aff8-4da2-9f82-4fbd0ed7dd67","order_by":3,"name":"Yuegang Li","email":"","orcid":"","institution":"National Cancer Center, Chinese Academy of Medical Sciences and Peking Union Medical College","correspondingAuthor":false,"prefix":"","firstName":"Yuegang","middleName":"","lastName":"Li","suffix":""},{"id":436018288,"identity":"2cfbe8c6-9880-45ff-835c-83089ccba8f8","order_by":4,"name":"Yuhan Wang","email":"","orcid":"","institution":"National Cancer Center, Chinese Academy of Medical Sciences and Peking Union Medical College","correspondingAuthor":false,"prefix":"","firstName":"Yuhan","middleName":"","lastName":"Wang","suffix":""},{"id":436018289,"identity":"59bddc74-790f-4d1f-aefb-6d21aeeecd91","order_by":5,"name":"Huiyong Niu","email":"","orcid":"","institution":"Hebei University","correspondingAuthor":false,"prefix":"","firstName":"Huiyong","middleName":"","lastName":"Niu","suffix":""},{"id":436018290,"identity":"1917ca05-87c4-46dd-8e3b-5b2f04133b34","order_by":6,"name":"Lan Mei","email":"","orcid":"","institution":"Hebei University","correspondingAuthor":false,"prefix":"","firstName":"Lan","middleName":"","lastName":"Mei","suffix":""},{"id":436018291,"identity":"6c5fc07c-1d78-4f87-bac2-ff826b3b4e6e","order_by":7,"name":"Wei Zhao","email":"","orcid":"","institution":"National Cancer Center, Chinese Academy of Medical Sciences and Peking Union Medical 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Liu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAwElEQVRIiWNgGAWjYBACPmYILcfeAKIMLAhrYYNqMeY5ANYiQYQWKJ3YA9bCQIwWdh7D2wU1duk97D2mG34USDDwt3cnEHAYj7H1jGPJuT08x9Ju9gAdJnHm7AZCWsykeRsO5O6XSD52gweoxUAilzgt6TwSiW03/5CiJYEHaMttIm1hK7bmOZZsCPLLbRkDCR6CfuHnP7zxNk+NnTwPe4/ZzTd/bOT423vxawEBlLjgIagcQ8soGAWjYBSMAgwAAIUqOKgJHR6XAAAAAElFTkSuQmCC","orcid":"","institution":"National Cancer Center, Chinese Academy of Medical Sciences and Peking Union Medical College","correspondingAuthor":true,"prefix":"","firstName":"Qian","middleName":"","lastName":"Liu","suffix":""}],"badges":[],"createdAt":"2024-10-15 05:38:24","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5265259/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5265259/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s10151-025-03167-7","type":"published","date":"2025-07-13T15:57:52+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":79802697,"identity":"18d90862-f073-4b5b-8fe5-bd3f8046e818","added_by":"auto","created_at":"2025-04-03 04:30:51","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":111568,"visible":true,"origin":"","legend":"\u003cp\u003eStudy flowchart\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5265259/v1/572fc042ebd18280cbab378d.jpg"},{"id":79803201,"identity":"4981205e-adde-4d29-971f-787fdd7ae8b8","added_by":"auto","created_at":"2025-04-03 04:38:51","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":434540,"visible":true,"origin":"","legend":"\u003cp\u003eThe LLND in ICG-LLND group and control group. Obturator lymph node in bright light mode (a) and ICG NIRI mode (b); proximal internal iliac lymph node in bright light mode (c) and ICG NIRI mode (d); distal iliac lymph nodes in bright light mode (e) and ICG NIRI mode (f).\u003c/p\u003e","description":"","filename":"Figure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5265259/v1/556e0439fef643aa5096d47e.jpg"},{"id":86699417,"identity":"19baff1f-883b-454e-b9a2-d55d4f03661b","added_by":"auto","created_at":"2025-07-14 16:09:14","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1690922,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5265259/v1/dc1fa605-2bab-4aff-b153-f601ecb1ddd8.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Fluorescence Lymph Node Mapping Using ICG Improves Lateral Lymph Node Dissection for Mid-Low Rectal Cancer: A Propensity Score-Matched Cohort","fulltext":[{"header":"Introduction","content":"\u003cp\u003eComplete resection of the primary tumor and its associated lymph nodes is crucial for effectively treating rectal cancer. The number of lymph nodes retrieved plays a significant role in determining long-term oncological outcomes in advanced colorectal cancer. Total mesorectal excision (TME) remains the standard surgical approach for this condition.[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Patients with advanced lower rectal cancer, especially those with tumors at or below the peritoneal reflection, sometimes develop metastases to the lateral lymph nodes (LLNs). These nodes are a significant site for postoperative local recurrence[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Diagnosing and treating patients with LLN metastasis (LLNM) present considerable challenges. The surgical risks and potential morbidity associated with lateral lymph node dissection (LLND), coupled with uncertain oncological outcomes, have made LLND a contentious and less frequently performed procedure, particularly when pathological findings in the lateral lymph nodes are negative[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePreoperative radiological examinations have detected LLNM in 14\u0026ndash;20% of cases with locally advanced low rectal cancer during the initial assessment. However, these methods remain insufficient, and some instances of LLNM go undetected.[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Lateral lymph node dissection (LLND) presents significant technical challenges and is often debated due to the difficulty in distinguishing lateral lymph nodes from actual lymphatic pathways originating from the primary tumor during surgery. This complexity makes it tough to ensure that the correct regions are targeted and that the dissection is complete.\u003c/p\u003e \u003cp\u003eAchieving precise identification and comprehensive removal of metastatic lateral lymph nodes (LLNs) during surgery could potentially enhance survival rates for patients with advanced rectal cancer. Consequently, an intraoperative visual technique that facilitates easy identification of LLNs and their lymphatic drainage pathways is crucial for surgeons to achieve optimal oncological outcomes[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Indocyanine green (ICG) assisted LLND with near-infrared imaging (NIRI) emerges as a promising approach. The recent advancements in NIRI systems for minimally invasive surgery have led to increased utilization of fluorescence imaging in colorectal procedures[\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. When injected into peritumoral areas, ICG disseminates through the lymphatic system and attaches to macrophages within the lymph nodes. NIRI system facilitates real-time visualization of lymph nodes and their drainage pathways during surgery[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Although some studies have explored the use of indocyanine green (ICG) for lateral lymph node dissection (LLND) in rectal cancer[\u003cspan additionalcitationids=\"CR13\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], more evidence is needed to define its impact on the number of harvested lateral lymph nodes and specific subgroups.\u003c/p\u003e \u003cp\u003eThe utility of ICG in lateral lymph node dissection remains debated, with current analyses considering the lateral lymph nodes collectively. No studies have subdivided the lateral lymph nodes to evaluate the specific application value of ICG NIRI in these subgroups. This study aimed to determine whether grouping LLNs could enhance the effectiveness of ICG NIRI in LLND.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003ePatients\u003c/h2\u003e \u003cp\u003eWe enrolled 223 patients who underwent laparoscopy-assisted TME and LLND for mid and low adenocarcinoma of the rectum between January 2018 and December 2023 at the Cancer Hospital, Chinese Academy of Medical Sciences, and Peking Union Medical College in China (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). This study was approved by the Ethics Committee of the Clinical Trials Center of the National Cancer Center. All participants provided written informed consent, which was obtained prior to their participation in the study, and permission from the ethics committee was granted to conduct the research. The inclusion criteria were patients with adenocarcinoma of the rectum, aged over 18 years. The exclusion criteria included patients under 18 years of age (n\u0026thinsp;=\u0026thinsp;1), those diagnosed with a pathology other than adenocarcinoma, such as adenoma or adenocarcinoma in situ (n\u0026thinsp;=\u0026thinsp;3), those who underwent combined resection of other organs (n\u0026thinsp;=\u0026thinsp;2) or emergency surgery (n\u0026thinsp;=\u0026thinsp;2), and those with distant metastasis at the time of first diagnosis (n\u0026thinsp;=\u0026thinsp;4).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eFluorescence-guided lymph nodes dissection\u003c/h3\u003e\n\u003cp\u003eThe Pelvic or rectal magnetic resonance imaging (MRI) is crucial for diagnosing lateral lymph node metastasis. LLNM in mid-low rectal cancer was primarily diagnosed based on the short axis of lymph nodes\u0026thinsp;\u0026ge;\u0026thinsp;7 mm at the time of initial diagnosis. This criterion was supplemented by the assessment of malignant imaging features and clinical-pathological high-risk factors. In cases where the short axis of the lymph nodes was \u0026lt;\u0026thinsp;7 mm but two or more malignant imaging characteristics were present, clinical diagnosis of positive lymph nodes was considered.\u003c/p\u003e \u003cp\u003eFluorescence-guided lymph node dissection enhanced lymph node mapping in rectal cancer through ICG endoscopic tattooing. A total of 0.25 ml of ICG (2.5 mg/ml) was injected submucosally at four sites around the tumor to optimize lymphatic drainage. Administered one hour before surgery, ICG improved tumor visibility with laparoscopic NIR camera. This study builds on the previously described fluorescence-assisted lateral lymph node dissection technique[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] and facilitated identification of fluorescent lymph nodes, including internal iliac (station 263), obturator (station 283), external iliac (station 293), and common iliac (station 273) nodes. During lateral lymph node dissection, the primary focus is on the obturator (station 283) and internal iliac (station 263) nodes, as these are the most common sites of metastasis in rectal cancer. In some patients, dissection may also extend to the external iliac (station 293) and common iliac (station 273) lymph nodes, depending on the extent of the disease and the surgical strategy. This approach ensures thorough clearance of regional lymph nodes, helping to reduce the risk of recurrence. Procedures were conducted by skilled surgeons using a standard 5-port laparoscopic technique, focusing on key dissection areas to preserve autonomic nerves linked to pelvic lymph node metastasis. Dissection began with careful preservation of the ureteric hypogastric fascia and hypogastric nerve, accessing obturator lymph nodes while protecting critical vessels and nerves. This approach ensured complete preservation of autonomic nerve function.\u003c/p\u003e\n\u003ch3\u003ePathologic evaluation\u003c/h3\u003e\n\u003cp\u003eAfter completing the surgical procedure, the specimen was extracted through a mini-laparotomy incision. In the ICG-LLND group, the surgeon harvested fluorescent lymph nodes using a laparoscopic NIR camera for guidance, labeling them by anatomical location. In the control group, excised tissue was placed on an auxiliary table, and lymph nodes near the ligation sites were examined and dissected without fluorescence imaging. Lateral lymph nodes are classified into several key stations based on their location relative to major pelvic arteries. Station 263 refers to the internal iliac lymph nodes, which are critical in rectal cancer metastasis. Station 283 includes the obturator lymph nodes, another common site of lateral metastasis. Station 293 represents the external iliac lymph nodes, which are occasionally involved in the spread of rectal cancer. Station 273 corresponds to the common iliac lymph nodes, which may be included in certain cases of extensive metastasis. Pathological assessments were conducted separately for fluorescent and non-fluorescent LLNs, with hematoxylin and eosin staining performed to identify metastatic lymph nodes. The pathologist counted the harvested and metastatic lymph nodes in the three designated regions.\u003c/p\u003e\n\u003ch3\u003eClinical Outcomes\u003c/h3\u003e\n\u003cp\u003eThe effectiveness of ICG NIRI in LLND during laparoscopic TME was evaluated by comparing harvested and metastatic lymph node counts between ICG-LLND and control groups, focusing on LLNs. In the ICG-LLND group, lymphatic drainage routes were analyzed, and metastatic lymph node locations were compared with these pathways. Additionally, factors influencing the number of harvested and metastatic lymph nodes in patients undergoing laparoscopy-assisted TME with LLND were identified.\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eStatistical analyses were performed to compare outcomes between the ICG-LLND group and conventional group (control group) focusing on harvested and metastatic lymph node counts, and the detection rate of metastatic lateral lymph nodes. The Student's t-test compared mean lymph node counts, while Pearson\u0026rsquo;s Chi-square and Fisher\u0026rsquo;s exact tests assessed categorical variables related to detection rates. To control for potential confounding variables, propensity score matching (PSM) was applied to achieve balanced baseline characteristics between the ICG-LLND and control groups. Propensity scores were calculated using logistic regression, incorporating clinically relevant variables. After matching, the baseline characteristics between the two groups were assessed for balance, with all P values greater than 0.05 and standardized mean differences (SMD) around 0.1. Simple linear regression identified clinicopathologic variables linked to lymph node counts, and multivariable linear regression evaluated factors associated with these counts. Analyses were conducted using SPSS 27.0 and R 4.3.0, with statistical significance set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003ePatients\u003c/h2\u003e \u003cp\u003eThe clinicopathological characteristics of the patients were comparable between the ICG-LLND and control groups, as presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. No adverse events were associated with the submucosal ICG injection. The optimal ICG-LLND protocol demonstrated a high success rate of 98.3%. There was one instance of ICG-LLND failure involving a female patient with a high body mass index (BMI) and thick mesenteric fat tissue, which compromised fluorescent lymphatic drainage.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe basic characteristics of patients before and after PSM.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003eBefore PSM\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e \u003cp\u003eAfter PSM\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClinical variables\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;156 (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eICG-LLND,\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;67 (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eControl, n\u0026thinsp;=\u0026thinsp;51 (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eICG-LLND,\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;51(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eSMD\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge, yr\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003emean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56.9\u0026thinsp;\u0026plusmn;\u0026thinsp;11.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e57.9\u0026thinsp;\u0026plusmn;\u0026thinsp;11.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.518\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e57.2\u0026thinsp;\u0026plusmn;\u0026thinsp;11.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e58.8\u0026thinsp;\u0026plusmn;\u0026thinsp;12.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.816\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e84 (53.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35 (52.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.825\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e28 (54.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e27 (52.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.119\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e72 (46.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32 (47.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e23 (45.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e24 (47.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003emale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61 (39.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31 (46.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.319\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e24 (47.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e21 (41.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.550\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.150\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003efemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95 (60.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36 (53.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e27 (52.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e30(58.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI (kg/m2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003emean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24.4\u0026thinsp;\u0026plusmn;\u0026thinsp;3.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24.3\u0026thinsp;\u0026plusmn;\u0026thinsp;3.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.913\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e24.2\u0026thinsp;\u0026plusmn;\u0026thinsp;3.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e23.5\u0026thinsp;\u0026plusmn;\u0026thinsp;3.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.562\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e72 (46.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26 (38.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.311\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e27 (52.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e26 (51.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.854\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.081\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e84 (53.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e41 (61.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e24 (47.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e25 (49.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ecT status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ecT 1\u0026ndash;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23 (14.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23 (34.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10 (19.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e13 (25.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.636\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.140\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ecT 3\u0026ndash;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e133 (85.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e44 (65.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e41 (80.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e38 (74.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ecN status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ecN 0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44 (28.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31 (46.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.009\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e20 (39.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e22 (43.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.841\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.080\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ecN 1\u0026ndash;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e112 (71.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36 (53.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e31 (60.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e29 (56.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003epT status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003epT 1\u0026ndash;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46 (29.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34 (50.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e21 (41.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e22 (43.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.076\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003epT 3\u0026ndash;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e110 (70.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33 (49.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e30 (58.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e29 (56.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003epN status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003epN 0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53 (34.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33 (49.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.032\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e22 (43.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e24 (47.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.842\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.079\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003epN 1\u0026ndash;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e103 (66.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34 (50.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e29 (56.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e27 (52.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePathologic stage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eI-II\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54 (34.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33 (49.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.057\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e22 (43.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e24 (47.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.842\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.085\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIII-IV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e102 (65.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34 (5.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e29 (56.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e27 (52.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTumor size (cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003emean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.0\u0026thinsp;\u0026plusmn;\u0026thinsp;1.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.0\u0026thinsp;\u0026plusmn;\u0026thinsp;1.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.931\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4.0\u0026thinsp;\u0026plusmn;\u0026thinsp;1.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.512\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;4.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95 (60.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e39 (58.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.707\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e32 (62.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e30 (58.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.839\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.080\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;4.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61 (39.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28 (41.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e19 (37.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e21 (41.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003enCRT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61 (39.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37 (55.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.026\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e22 (43.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e24 (47.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.842\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.079\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95 (60.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30 (45.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e29 (56.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e27 (52.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDifferentiation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWell/moderate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e98 (62.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37 (55.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.287\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e27 (52.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e29 (56.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.842\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.078\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePoorly\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58 (37.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30 (44.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e24 (47.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e22 (43.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLymphatic invasion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNegative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e92 (59.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e41 (61.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.757\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e34 (66.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e32 (62.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.836\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.082\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePositive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64 (41.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26 (38.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e17 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e19 (37.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVascular invasion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNegative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e96 (61.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e51 (76.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.035\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e40 (78.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e37 (72.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.645\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.137\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePositive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60 (38.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16 (23.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e11 (21.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e14 (27.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePerineural invasion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNegative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e87 (55.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e38 (56.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.896\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e33 (64.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e31 (60.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.838\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.081\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePositive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e69 (44.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29 (43.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e18 (35.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e20 (39.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"9\" nameend=\"c9\" namest=\"c1\"\u003e \u003cp\u003eNote: ICG-LLND: Indocyanine Green Lymph Node Detection; PSM: Propensity Score Matching; Control: The standard procedure group without ICG lymph node detection; ICG-LLND: The group using indocyanine green for lymph node detection; BMI: Body Mass Index; cT: Clinical Tumor stage; cN: Clinical Node stage; pT: Pathologic Tumor stage; pN: Pathologic Node stage; SMD: Standardized Mean Difference; nCRT: Neoadjuvant Chemotherapy; Median (Range): The median number of nodes with the range in parentheses; pT, pN, cT, and cN stages refer to the classifications of tumor and node involvement based on pathological and clinical evaluations.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eBaseline characteristics of the primary cohort indicated that patients who underwent ICG-LLND had higher rates of tumor stage (P\u0026thinsp;=\u0026thinsp;0.002), nodal stage (P\u0026thinsp;=\u0026thinsp;0.032), nCRT (P\u0026thinsp;=\u0026thinsp;0.026), and vascular invasion (P\u0026thinsp;=\u0026thinsp;0.035). After PSM, these baseline characteristics were well balanced (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003ePostoperative outcomes and complications comparison\u003c/h3\u003e\n\u003cp\u003eThe postoperative outcomes showed key differences between the control and ICG-LLND groups. Before matching, the ICG-LLND group had a shorter hospital stay (6 vs. 7 days, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and after matching, it was also shorter (5 vs. 6 days, P\u0026thinsp;=\u0026thinsp;0.001). Blood loss was lower in the ICG-LLND group, though not significantly (30 vs. 50 ml, P\u0026thinsp;=\u0026thinsp;0.185 before matching; 20 vs. 50 ml, P\u0026thinsp;=\u0026thinsp;0.422 after matching). Operating time was similar (P\u0026thinsp;=\u0026thinsp;0.305 before, P\u0026thinsp;=\u0026thinsp;0.937 after matching). The ICG-LLND group had fewer anastomotic leakage cases (1 vs. 6 before matching, 1 vs. 2 after matching, P\u0026thinsp;=\u0026thinsp;0.206). In terms of complications, six patients in the control group and one patient in the ICG-LLND group experienced postoperative anastomotic leakage, and two patients in the control group had postoperative anastomotic bleeding.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003ePostoperative lymph node harvesting and dissection outcomes between ICG-LLND group and control group\u003c/h2\u003e \u003cp\u003eThe median number of total harvested lymph nodes was significantly higher in the ICG-LLND group compared to the control group (31 vs. 26, P\u0026thinsp;=\u0026thinsp;0.001), as well as the number of harvested lateral lymph nodes (LLNs) (11 vs. 7, P\u0026thinsp;=\u0026thinsp;0.002) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). However, there was no significant difference in the number of positive total lymph nodes (3 vs. 5, P\u0026thinsp;=\u0026thinsp;0.409) or positive LLNs (1 vs. 2, P\u0026thinsp;=\u0026thinsp;0.142) between the two groups. After propensity score matching (PSM), the ICG-LLND group continued to show a significantly higher number of harvested total lymph nodes (32 vs. 25, P\u0026thinsp;=\u0026thinsp;0.001) and harvested LLNs (8 vs. 6, P\u0026thinsp;=\u0026thinsp;0.008) compared to the control group. Additionally, the postoperative hospital stay was significantly shorter in the ICG-LLND group (5 vs. 6 days, P\u0026thinsp;=\u0026thinsp;0.001). Regarding specific lymph node stations, the median number of harvested station 283 nodes was significantly higher in the ICG-LLND group compared to the control group (6 vs. 4, P\u0026thinsp;=\u0026thinsp;0.001). The number of positive station 283 nodes was also higher in the ICG-LLND group before (2 vs. 1, P\u0026thinsp;=\u0026thinsp;0.027) after PSM (2 vs. 1, P\u0026thinsp;=\u0026thinsp;0.013). No significant differences were observed in the number of harvested station 263 (3 vs. 3, P\u0026thinsp;=\u0026thinsp;0.119), station 273 (4 vs. 4, P\u0026thinsp;=\u0026thinsp;0.056), or station 293 (3 vs. 3, P\u0026thinsp;=\u0026thinsp;0.609) lymph nodes between the two groups before or after PSM (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). The lateral lymph node dissection (LLND) outcomes for both groups are shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePostoperative lymph node results in mid-low rectal cancer patients before (n\u0026thinsp;=\u0026thinsp;223) and after (n\u0026thinsp;=\u0026thinsp;102) PSM\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eBefore match\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eAfter match\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;156)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eICG-LLND\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;67)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;51)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eICG-LLND\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;51)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of harvested total nodes, median (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26 (6,69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31 (11,61)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e25 (11,58)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e32 (14,80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of positive harvested total nodes, median (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (1,24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (1,28)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.409\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (1,11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3 (1,15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.731\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of harvested lateral lymph nodes, median (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (1,29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (1,31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6 (1,23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8 (1,25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.008\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of positive lateral lymph nodes, median (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (1,8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (1,10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.142\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (1,3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1 (1,10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.254\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of harvested station 283 nodes, median (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (1,13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (1,21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 (1,9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5 (1,14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.012\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of positive station 283 nodes, median (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (1,2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (1,6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.027\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (1,2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2 (1,4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.013\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of harvested station 263 nodes, median (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (1,14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (1,15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.119\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (1,8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3 (1,8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.157\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of positive station 263 nodes, median (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (1,16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (1,5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.260\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (1,2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1 (1,3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.170\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of harvested station 293 nodes, median (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (1,9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (1,10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.609\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (1,1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1 (1,1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.673\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of positive station 293 nodes, median (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (1,3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (1,4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.435\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (1,3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1 (1,3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.417\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of harvested station 273 nodes, median (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (1,9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (1,13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.056\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 (1,9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5 (1,13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.539\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of positive station 273 nodes, median (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (1,2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (1,3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.490\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (1,1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1 (1,1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.945\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003eNote: ICG-LLND: Indocyanine Green Lymph Node Detection; PSM: Propensity Score Matching; Control: The standard procedure group without ICG lymph node detection; ICG-LLND: The group using indocyanine green for lymph node detection; Median (Range): The median number of nodes with the range in parentheses.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePostoperative outcomes and complications in patients before (n\u0026thinsp;=\u0026thinsp;223) and after (n\u0026thinsp;=\u0026thinsp;102) PSM\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eBefore match\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eAfter match\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;156)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eICG-LLND\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;67)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;51)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eICG-LLND\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;51)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative hospital stay (day), median (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (3,47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (2,19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6 (3,12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5 (2,8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEstimated blood loss (ml), median (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50 (5,600)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30 (5,600)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.185\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e50 (5,700)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e20 (5,400)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.422\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOperating time (min), median (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e250 (76,689)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e246 (127,527)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.305\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e24 (75,486)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e247 (88, 485)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.937\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComplications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.206\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eintraoperative bleeding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eanastomotic leakage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eileus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eincisional infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003eNote: ICG-LLND: Indocyanine Green Lymph Node Detection; PSM: Propensity Score Matching; Control: The standard procedure group without ICG lymph node detection; ICG-LLND: The group using indocyanine green for lymph node detection; Median (Range): The median number of nodes with the range in parentheses.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe univariate and multivariate analysis of risk factors for harvested lateral lymph nodes\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eClinicopathological variables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"6\" nameend=\"c7\" namest=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eUnivariate analysis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eMultivariate analysis\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBeta\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBeta\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.104\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.139, 0.016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.120\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-2.117, 1.463\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.719\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.010\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.260, 0.302\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.883\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003enCRT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.223\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.261, 4.724\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.179\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.637, 4.161\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.008\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003epT stage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.080\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-1.246, 0.308\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.236\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003epN stage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.158\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.250, 2.650\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.071\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-1.883, 0.573\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.294\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDifferentiation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.064\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-2.666, 0.934\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.344\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLymphatic invasion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.105\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-3.207, 0.367\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.119\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVascular invasion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.075\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-2.904, 0.805\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.266\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePerineural invasion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.099\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-3.090, 0.446\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.142\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eICG-LLND\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.224\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.376, 5.125\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.180\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.712, 4.521\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.007\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eNote: the pN stage was classified without the status of lateral lymph nodes; nCRT, neoadjuvant chemotherapy.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eUnivariate and Multivariate Analysis of NIRI for LLND\u003c/h2\u003e \u003cp\u003eLymph node count was associated with various clinicopathological variables. In the simple linear regression model (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e), the ICG-LLND (Beta\u0026thinsp;=\u0026thinsp;0.224, 95% CI\u0026thinsp;=\u0026thinsp;1.376\u0026ndash;5.125, P\u0026thinsp;=\u0026thinsp;0.001) and positive pN stage (Beta\u0026thinsp;=\u0026thinsp;0.158, 95% CI\u0026thinsp;=\u0026thinsp;0.250\u0026ndash;2.650, P\u0026thinsp;=\u0026thinsp;0.018) had an impact that increased the harvested LLNs count. In the multivariable linear regression analysis, nCRT (Beta\u0026thinsp;=\u0026thinsp;0.179, 95% CI\u0026thinsp;=\u0026thinsp;0.637\u0026ndash;4.161, P\u0026thinsp;=\u0026thinsp;0.008) and ICG-LLND (Beta\u0026thinsp;=\u0026thinsp;0.180, 95% CI\u0026thinsp;=\u0026thinsp;0.712\u0026ndash;4.521, P\u0026thinsp;=\u0026thinsp;0.007) was confirmed as independent associated factors that could increase the harvested lymph node count.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe univariate and multivariate analysis of risk factors for metastatic lateral lymph nodes\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" morerows=\"2\" nameend=\"c2\" namest=\"c1\" rowspan=\"3\"\u003e \u003cp\u003eClinicopathological variables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"6\" nameend=\"c8\" namest=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003eUnivariate analysis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e \u003cp\u003eMultivariate analysis\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBeta\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eBeta\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.016, 0.016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.977\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.063\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.541, 0.193\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.351\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.075\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.090, 0.025\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.265\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003enCRT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.412\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.234, 0.725\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.124\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.034, 0.716\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.075\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003epT stage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.184\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.064, 0.379\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.006\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.047\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.100, 0.214\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.476\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003epN stage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.355\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.435, 0.901\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.163\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.025,0.590\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.033\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDifferentiation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.210\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.225, 0.949\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.082\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.136,0.594\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.218\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLymphatic invasion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.347\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.620, 1.312\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.190\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.079, 0.976\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVascular invasion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.331\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.594, 1.315\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.145\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.030,0.863\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.067\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePerineural invasion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.292\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.455, 1.152\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.059\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.263,0.586\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.454\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eICG-LLND\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.099\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.687, 0.099\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.142\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003eNote: the pN stage was classified without the status of lateral lymph nodes; nCRT, neoadjuvant chemotherapy.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe risk factors for lateral nodal metastasis were also analyzed (Table\u0026nbsp;6). Pathological T3-4 stage (P\u0026thinsp;=\u0026thinsp;0.006), positive pN stage except for LLNs (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), underwent nCRT (P\u0026thinsp;=\u0026thinsp;0.002), poor differentiation level (P\u0026thinsp;=\u0026thinsp;0.002), and lymphatic, vascular (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), or perineural invasion (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) were associated with positive LLNs. In the multivariable linear regression analysis, the lymphatic invasion (Beta\u0026thinsp;=\u0026thinsp;0.190, 95% CI\u0026thinsp;=\u0026thinsp;0.079, 0.976, P\u0026thinsp;=\u0026thinsp;0.021) and positive pN stage except for LLNs (Beta\u0026thinsp;=\u0026thinsp;0.163, 95% CI\u0026thinsp;=\u0026thinsp;0.025\u0026ndash;0.590, P\u0026thinsp;=\u0026thinsp;0.033) was an independent risk factor for LLNs metastasis.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe LLNs recurrence remains one of the primary causes of local treatment failure following radical surgery for locally advanced rectal cancer[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Although routine LLND can effectively remove potential metastatic lymph nodes, its impact on overall patient survival remains a topic of debate[\u003cspan additionalcitationids=\"CR19\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. This controversy stems largely from the limitations of current diagnostic techniques in accurately identifying LLNM, which can result in either incomplete or excessive dissection, both of which may negatively influence patient outcomes. Moreover, the metastatic potential of different LLN groups is not yet fully understood. Thus, improving the precision of intraoperative identification of LLNs is critical for reducing surgical complications and improving oncological outcomes.\u003c/p\u003e \u003cp\u003eIn this study, we retrospectively analyzed 223 patients who underwent TME and LLND. The risk of LLNM was assessed for each patient group, and the role of ICG NIRI as a surgical navigation tool was evaluated. LLNM in rectal cancer is predominantly found in the internal iliac nodes and obturator nodes, which are key anatomical regions for dissection. Our findings demonstrated that ICG NIRI significantly increased the number of harvested lymph nodes, particularly LLNs. In multivariate analysis, ICG-LLND was identified as independent factors that increased the total number of harvested LLNs. However, consistent with previous studies, the uses of ICG NIRI did not result in an increase in the number of positive lymph nodes[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. The technique was particularly effective in increasing both the total and positive number of obturator lymph nodes retrieved, although no significant improvement was observed for internal iliac nodes. This result may be closely related to the properties of the ICG fluorescent dye. ICG fluorescence primarily detects normal lymph nodes that drain from the tumor surrounding area, while the imaging efficacy of ICG fluorescence is poor for regions that have been invaded by cancer tissue, which may lead to weakened or absent fluorescence signals. Specifically, ICG fluorescence is effective in distinguishing normal lymph nodes but has limited effectiveness when it comes to identifying lymph nodes invaded by tumors [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. This finding is particularly important for the development of near-infrared fluorescence-based surgical navigation strategies, suggesting that when using ICG fluorescence for surgical navigation, it may be necessary to combine it with other techniques or markers to more effectively identify lymph nodes that have been invaded by tumors.\u003c/p\u003e \u003cp\u003eThe advantage of ICG-LLND lies in its real-time navigation capability, enabling surgeons to accurately locate and excise LLNs during surgery. The strong affinity of ICG for the lymphatic system facilitates rapid and precise visualization of lymph nodes, thereby enhancing detection sensitivity[\u003cspan additionalcitationids=\"CR23\" citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Additionally, the ICG NIRI assists in identifying smaller or occult metastatic lymph nodes, reducing the risk of missed detections while also minimizing unnecessary dissection, which can improve overall surgical outcomes[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAnatomically, obturator lymph nodes are located on the external surface of the bladder's hypogastric fascia and are surrounded by a relatively complete fascial capsule, making them more straightforward to dissect. In contrast, internal iliac lymph nodes are often positioned near critical vascular structures such as the inferior vesical and internal pudendal arteries, which complicates complete excision[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. The ICG NIRI is highly effective in identifying and dissecting obturator lymph nodes but proves less helpful for internal iliac lymph nodes, especially those located behind blood vessels. To ensure complete lymph node dissection, thorough exposure of the internal iliac artery and its branches, combined with adherence to fascia-oriented surgical techniques, is essential. Ongoing advancements in ICG NIRI technology, including the development of more specific fluorescent probes, are needed to improve the visualization of deeper or hidden lymph nodes.\u003c/p\u003e \u003cp\u003eImportantly, no significant differences in postoperative complications\u0026mdash;including intraoperative bleeding, anastomotic leakage, ileus, and incisional infection\u0026mdash;were observed between the ICG-LLND and control groups. This suggests that ICG NIRI does not contribute to overtreatment in the short term. The precision of ICG NIRI likely contributed to reduced surgical trauma, minimized unnecessary tissue dissection, and enhanced operative efficiency, which may explain the shorter postoperative hospital stays observed in the ICG-LLND group. By improving surgical accuracy, ICG NIRI may also reduce the incidence of postoperative complications such as lymphatic leakage and infection, thereby accelerating patient recovery.\u003c/p\u003e \u003cp\u003eDespite these promising short-term benefits, the potential risk of overtreatment with ICG NIRI cannot be entirely ruled out, particularly if unnecessary lymph node dissection results in long-term complications. However, no evidence of overtreatment was observed in this study. To comprehensively assess the long-term impact of ICG NIRI, including oncological outcomes such as overall survival and disease-free survival, further follow-up is required.\u003c/p\u003e \u003cp\u003eLimitations of this study include its retrospective design, which may introduce selection bias despite the use of propensity score matching. Additionally, the impact of preoperative neoadjuvant therapies, such as radiation, on lymph node harvest was not fully explored and should be further investigated. Another limitation of ICG NIRI was its reduced efficacy in identifying deeper or hidden lymph nodes, particularly around the internal iliac vessels, which underscores the need for improved visualization techniques and more specific fluorescent probes. Further prospective studies are required to address these limitations and refine the use of ICG NIRI in surgical practice.\u003c/p\u003e \u003cp\u003eIn conclusion, the ICG NIRI shows promise as a strategy to enhance the accuracy of LLND in rectal cancer surgery. It significantly increases lymph node harvest while reducing postoperative hospital stays without raising the risk of short-term complications. However, careful evaluation of long-term outcomes and potential overtreatment risks is necessary. Future prospective studies are essential to fully understand the long-term implications and to further optimize ICG NIRI technology.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eThis research was funded by the National Key Research and Development Program (No. 2022YFC2505003), CAMS Innovation Fund for Medical Sciences (No. 2022-12M-C\u0026amp;T-B-057), National Natural Science Foundation of Beijing Municipality (No. 4232058)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest:\u003c/strong\u003e The authors declare no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval and consent to participate:\u0026nbsp;\u003c/strong\u003eEthics reference number is NCC2024C-793, which is approved by Ethics Committee of the Clinical Trials Center of National Cancer Center (Phone + 0086 010 87787112). All participants gave their written informed consent to participate in this study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability:\u0026nbsp;\u003c/strong\u003eThe datasets generated and/or analyzed during the current study are not publicly available due to privacy and confidentiality concerns but are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u0026nbsp;\u003c/strong\u003eData and materials related to this study are available from the corresponding author upon reasonable request. Restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. However, access may be granted by the authors on a case by-case basis.\u003c/p\u003e\n"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eKnol J, Keller DS Total Mesorectal Excision Technique-Past, Present, and Future. Clin Colon Rectal Surg 33\u003cstrong\u003e:\u003c/strong\u003e134-143\u003c/li\u003e\n\u003cli\u003eWilliamson JS, Quyn AJ, Sagar PM Rectal cancer lateral pelvic sidewall lymph nodes: a review of controv ersies and management. Br J Surg 107\u003cstrong\u003e:\u003c/strong\u003e1562-1569\u003c/li\u003e\n\u003cli\u003eSammour T, Bedrikovetski S Radiomics for Diagnosing Lateral Pelvic Lymph Nodes in Rectal Cancer: Artificial Intelligence Enabling Precision Medicine? Ann Surg Oncol 27\u003cstrong\u003e:\u003c/strong\u003e4082-4083\u003c/li\u003e\n\u003cli\u003eOtero de Pablos J, Mayol J Controversies in the Management of Lateral Pelvic Lymph Nodes in Patie nts With Advanced Rectal Cancer: East or West? 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Front Oncol 11\u003cstrong\u003e:\u003c/strong\u003e621914\u003c/li\u003e\n\u003cli\u003eMieog JSD, Achterberg FB, Zlitni A, Hutteman M, Burggraaf J, Swijnenburg R-J, Gioux S, Vahrmeijer AL Fundamentals and developments in fluorescence-guided cancer surgery. Nat Rev Clin Oncol 19\u003cstrong\u003e:\u003c/strong\u003e9-22\u003c/li\u003e\n\u003cli\u003eZhang Z, He K, Chi C, Hu Z, Tian J Intraoperative fluorescence molecular imaging accelerates the coming o f precision surgery in China. Eur J Nucl Med Mol Imaging 49\u003cstrong\u003e:\u003c/strong\u003e2531-2543\u003c/li\u003e\n\u003cli\u003eShiraishi T, Sasaki T, Tsukada Y, Ikeda K, Nishizawa Y, Ito M Radiologic Factors and Areas of Local Recurrence in Locally Advanced L ower Rectal Cancer After Lateral Pelvic Lymph Node Dissection. Dis Colon Rectum 64\u003cstrong\u003e:\u003c/strong\u003e1479-1487\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Table 6","content":"\u003cp\u003eTable 6 is not available with this version.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"techniques-in-coloproctology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"tcol","sideBox":"Learn more about [Techniques in Coloproctology](http://link.springer.com/journal/10151)","snPcode":"10151","submissionUrl":"https://submission.nature.com/new-submission/10151/3","title":"Techniques in Coloproctology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"rectal cancer, lateral lymph node, indocyanine green, fluorescence-guide lymph node mapping, propensity score matching","lastPublishedDoi":"10.21203/rs.3.rs-5265259/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5265259/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Patients with lateral lymph node metastasis (LLNM) present particular challenges for both diagnosis and treatment. This study aimed to assess whether indocyanine green (ICG) assisted lymph node mapping with near-infrared imaging (NIRI) enhances the effectiveness of lateral lymph node dissection (LLND) by further categorizing the lateral lymph nodes in patients with mid-low rectal cancer.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eSubmucosal indocyanine green injection was performed on the distal margin of the rectal cancer. In the ICG-LLND group, the lymphatic drainage pathway and distribution of lateral lymph nodes (LLNs) were explored using a laparoscopic NIRI system. Pathological evaluations were conducted for both the ICG-LLND group and the control group.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eThe ICG-LLND group demonstrated a significantly shorter postoperative hospital stay compared to the control group, both before (P\u0026lt;0.001) and after (P=0.001) matching. While blood loss and operating time were similar between groups, the ICG-LLND group had fewer cases of anastomotic leakage (P=0.206). Postoperative lymph node harvesting was significantly higher in the ICG-LLND group, with more total lymph nodes (P=0.001) and lateral lymph nodes (P=0.002) harvested. The number of harvested lymph nodes in the obturator and internal iliac regions was also higher in the ICG-LLND group (P=0.001), and the number of positive lymph nodes in these regions was significantly greater before (P=0.027) and after (P=0.013) matching. Univariate and multivariate analyses showed that ICG-LLND, nCRT, and positive pN stage were associated with increased lymph node harvest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e ICG-LLND improved lateral lymph node harvest, particularly obturator lymph nodes, and shortened postoperative hospital stay without increasing complications. This technique may enhance surgical outcomes in patients requiring lymph node dissection.\u003c/p\u003e","manuscriptTitle":"Fluorescence Lymph Node Mapping Using ICG Improves Lateral Lymph Node Dissection for Mid-Low Rectal Cancer: A Propensity Score-Matched Cohort","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-03 04:30:46","doi":"10.21203/rs.3.rs-5265259/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-04-13T05:08:08+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-10T21:13:05+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"293403301168184964154726210255642620219","date":"2025-04-01T21:19:02+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-03-30T22:19:10+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-03-26T14:35:39+00:00","index":"","fulltext":""},{"type":"submitted","content":"Techniques in Coloproctology","date":"2025-03-26T05:25:33+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"techniques-in-coloproctology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"tcol","sideBox":"Learn more about [Techniques in Coloproctology](http://link.springer.com/journal/10151)","snPcode":"10151","submissionUrl":"https://submission.nature.com/new-submission/10151/3","title":"Techniques in Coloproctology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"57c3ee07-3349-4796-b23d-4aaf624821bc","owner":[],"postedDate":"April 3rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-07-14T16:03:24+00:00","versionOfRecord":{"articleIdentity":"rs-5265259","link":"https://doi.org/10.1007/s10151-025-03167-7","journal":{"identity":"techniques-in-coloproctology","isVorOnly":false,"title":"Techniques in Coloproctology"},"publishedOn":"2025-07-13 15:57:52","publishedOnDateReadable":"July 13th, 2025"},"versionCreatedAt":"2025-04-03 04:30:46","video":"","vorDoi":"10.1007/s10151-025-03167-7","vorDoiUrl":"https://doi.org/10.1007/s10151-025-03167-7","workflowStages":[]},"version":"v1","identity":"rs-5265259","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5265259","identity":"rs-5265259","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}