Application of indocyanine green fluorescence navigation in endoscopic breast-conserving surgery with pedicled omental flap for breast cancer

doi:10.3877/cma.j.issn.1674-0807.2026.05.006

Abstract

Abstract:

Objective

To explore the efficacy of indocyanine green (ICG) fluorescence navigation for assessing the pedicled omental flap in endoscopic breast-conserving plastic surgery.

Methods

A retrospective analysis was performed on the clinical data of 70 breast cancer patients who underwent endoscopic breast-conserving plastic surgery with a pedicled omental flap at the Department of Breast Surgery, Zhujiang Hospital of Southern Medical University between August 2021 and August 2025. The patients were divided into the ICG group (35 patients) and the control group (35 patients) based on whether ICG fluorescence guidance was used during surgery. The control group comprised 35 patients treated between August 2021 and May 2024, in whom flap perfusion was assessed intraoperatively by the surgeon's naked-eye observation alone, without imaging guidance. The ICG group comprised 35 patients treated between June 2024 and August 2025, who received preoperative intravenous ICG injection and intraoperative fluorescence endoscopy employed for real-time visualization of the omental vascular anatomy and blood flow patterns to precisely guide the resection of the omental flap. The operative time, postoperative hospital stay, incidence of upper abdominal discomfort at 3 days postoperatively, incidence of omental flap necrosis at 2 weeks postoperatively, incidence of omental flap sclerosis at 1 month postoperatively, and breast aesthetic outcome at 3 months postoperatively were compared between the two groups. Breast aesthetic outcomes were evaluated at 3 months postoperatively using the Harris criteria. Continuous variables were analyzed using the independent samples t-test or Mann-Whitney U test; categorical variables were analyzed using the χ² test or Fisher's exact test; multivariate logistic regression was employed to adjust for confounding factors.

Results

There were no statistically significant differences in baseline characteristics between the two groups (all P>0.05), except for N-stage. Surgery was completed successfully in both groups. Compared with the control group, the operative time was significantly shorter in the ICG group [(343.89±83.84) min vs (274.57±79.75) min, t=−3.544, P=0.001], and the postoperative hospital stay was significantly reduced [(8.97±2.15) d vs (6.74±0.74) d, t=−5.801, P<0.001]. The ICG group also showed significantly lower incidences of upper abdominal discomfort (CTCAE ≥ grade 2) at 3 days postoperatively (14.29% vs 51.43%, χ²=10.944, P=0.001) and omental flap sclerosis at postoperative one month (22.86% vs 60.00%, χ²=9.950, P=0.002) compared with the control group. No significant difference was observed in the incidence of omental flap necrosis at 2 weeks postoperatively (5.71% vs 0, P=0.235). Multivariate logistic regression analysis identified ICG fluorescence navigation as an independent protective factor against upper abdominal discomfort (adjusted OR=0.156, 95%CI: 0.047-0.521, P=0.003) and omental flap sclerosis (adjusted OR=0.171, 95%CI: 0.056-0.527, P=0.002). At 3 months postoperatively, breast aesthetic outcomes evaluated by the Harris criteria were excellent in all 35 patients (100%) in the ICG group, compared with 29 excellent (82.86%), 4 good (11.43%), and 2 fair (5.71%) in the control group, indicating superior outcomes in the ICG group (Z=-2.541, P=0.011).

Conclusion

ICG fluorescence navigation provides real-time, intuitive imaging guidance for assessing omental flap perfusion during endoscopic breast-conserving oncoplastic surgery with a pedicled omental flap. It can shorten operative time, reduce perioperative complications, and improve postoperative breast aesthetic outcomes, demonstrating favorable clinical application value.

Key words: Breast neoplasms, Mastectomy, segmental, Omentum, Indocyanine green, Fluorescence imaging

Xian Li, Arslan Muhammad, Linyun He, Di Zhu, Yanwen Zhu, Pusheng Zhang. Application of indocyanine green fluorescence navigation in endoscopic breast-conserving surgery with pedicled omental flap for breast cancer[J]. Chinese Journal of Breast Disease(Electronic Edition), 2026, 20(05): 297-304.

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Figures/Tables 5

临床病理特征	ICG组（n=35）	对照组（n=35）	统计量值	P值
年龄（岁， $x ¯$ ±s）	43.29±7.39	42.54±8.88	t=0.380	0.705
BMI（kg/m²， $x ¯$ ±s）	22.61±3.27	22.68±2.77	t=0.096	0.924
T分期［例（%）］
T_is	1（2.86）	0（0）	Z=-0.358	0.720
T₁	12（34.29）	15（42.86）
T₂	21（60.00）	19（54.29）
T₃	1（2.86）	1（2.86）
N分期［例（%）］
N₀	21（60.00）	29（82.86）
N₁	13（37.14）	6（17.14）	Z=-2.141	0.032
N₂	1（2.86）	0（0）
肿瘤位置［例（%）］
内上象限	6（17.14）	12（34.29）	χ²=5.504	0.145
内下象限	1（2.86）	4（11.42）
外上象限	22（62.86）	16（45.71）
外下象限	6 （17.14）	3 （8.57）
ER ［例（%）］
阳性	27（77.14）	30（85.71）	χ²=0.850	0.356
阴性	8（22.86）	5（14.29）	χ²=0.850	0.356
PR ［例（%）］
阳性	27（77.14）	26（74.29）	χ²=0.078	0.780
阴性	8（22.86）	9（25.71）	χ²=0.078	0.780
HER-2［例（%）］
阳性	9（25.71）	9（25.71）	χ²=0.000	1.000
阴性	26（74.29）	26（74.29）	χ²=0.000	1.000
Ki-67［例（%）］
≤18%	9（25.71）	12（34.29）
>18%~<36%	5（14.29）	9（25.71）	Z=-1.435	0.151
≥36%	21（60.00）	14（40.00）

临床病理特征	ICG组（n=35）	对照组（n=35）	统计量值	P值
年龄（岁， $x ¯$ ±s）	43.29±7.39	42.54±8.88	t=0.380	0.705
BMI（kg/m²， $x ¯$ ±s）	22.61±3.27	22.68±2.77	t=0.096	0.924
T分期［例（%）］
T_is	1（2.86）	0（0）	Z=-0.358	0.720
T₁	12（34.29）	15（42.86）
T₂	21（60.00）	19（54.29）
T₃	1（2.86）	1（2.86）
N分期［例（%）］
N₀	21（60.00）	29（82.86）
N₁	13（37.14）	6（17.14）	Z=-2.141	0.032
N₂	1（2.86）	0（0）
肿瘤位置［例（%）］
内上象限	6（17.14）	12（34.29）	χ²=5.504	0.145
内下象限	1（2.86）	4（11.42）
外上象限	22（62.86）	16（45.71）
外下象限	6 （17.14）	3 （8.57）
ER ［例（%）］
阳性	27（77.14）	30（85.71）	χ²=0.850	0.356
阴性	8（22.86）	5（14.29）	χ²=0.850	0.356
PR ［例（%）］
阳性	27（77.14）	26（74.29）	χ²=0.078	0.780
阴性	8（22.86）	9（25.71）	χ²=0.078	0.780
HER-2［例（%）］
阳性	9（25.71）	9（25.71）	χ²=0.000	1.000
阴性	26（74.29）	26（74.29）	χ²=0.000	1.000
Ki-67［例（%）］
≤18%	9（25.71）	12（34.29）
>18%~<36%	5（14.29）	9（25.71）	Z=-1.435	0.151
≥36%	21（60.00）	14（40.00）

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