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Review
. 2025 Dec 20;18(1):22.
doi: 10.3390/cancers18010022.

Endoscopic Tattooing Using Indocyanine Green (ICG) Fluorescence for Intraoperative Guidance in Colorectal Surgery: Review of the Literature

Fotios Seretis  1 , Antonia Panagaki  2 , Georgios Tziatzios  2 , Paraskevas Gkolfakis  3 , Evdokia Romanou  4 , Vasilis Papastergiou  5 , Andreas Theodorou  6 , Andreas Kapiris  7 , Dimitrios Theodorou  6 , Tania Triantafyllou  6 , Stylianos Kapiris  1 , Konstantina Paraskeva  2
Affiliations
Review

Endoscopic Tattooing Using Indocyanine Green (ICG) Fluorescence for Intraoperative Guidance in Colorectal Surgery: Review of the Literature

Fotios Seretis et al. Cancers (Basel). .

Abstract

Background and objectives: Accurate endoscopic lesion localization is crucial for planning and performing curative-intent surgery in colorectal cancer management. The use of indocyanine green (ICG) has been described as a novel alternative for colorectal lesion marking.

Materials and methods: We have performed a systematic review of the literature on the use of ICG-based tattooing for patients with colorectal cancer undergoing surgery.

Results: A total of 19 studies were identified. Seven studies reposted the rates of successful intraoperative localization following ICG tattooing. Additionally, six studies provided detailed descriptions of the administration protocols, including both timing and dosage. A total of twelve studies described the utility of ICG-based tattooing for subsequent lymphadenectomy and its oncologic implications. Lymphadenectomy under fluorescent guidance was associated with increased lymph node yields as well as a change to the surgical lymphadenectomy plan in a significant proportion of patients.

Conclusions: ICG-based endoscopic tattooing has demonstrated significant value in facilitating precise lesion localization during curative-intent colorectal surgery. Moreover, its use has been extended to guiding lymphadenectomy, with reports indicating improved lymph node yields. Nevertheless, further research is required to standardize protocols and address existing limitations.

Keywords: ICG; colorectal cancer; endoscopy; indocyanine green; surgery; tattoo.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
PRISMA flowchart of the literature. (* corresponds to Pubmed and Embase databases).
See this image and copyright information in PMC

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