Indocyanine Green Fluorescence Guidance in Surgery for Locally Advanced Oral Squamous Cell Carcinoma After Neoadjuvant Immunotherapy
Li Jun, Gao Bingju, Qiu Yu, Lin Yang, Lin LisongABSTRACT
Objective
To explore the feasibility of indocyanine green (ICG) near‐infrared fluorescence guidance and margin‐related outcomes in patients undergoing surgery for locally advanced oral squamous cell carcinoma (OSCC) after neoadjuvant immunotherapy.
Methods
This retrospective single‐center cohort included 30 consecutive patients who underwent curative‐intent surgery between May 2024 and March 2025. Fifteen underwent ICG‐guided surgery and 15 underwent conventional surgery, according to routine clinical implementation and imaging availability. The primary outcome was patient‐level positive margin status on final pathological assessment. Recorded margin‐to‐tumor distances, intraoperative margin findings and perioperative outcomes were assessed separately. Comparisons were exploratory and unadjusted.
Results
Tumor‐associated fluorescence was visualized in all 15 ICG‐treated patients (100%; exact 95% confidence interval [CI], 78.2%–100%). Mean recorded margin‐to‐tumor distance was 9.30 ± 1.21 mm with ICG guidance and 16.40 ± 2.41 mm with conventional surgery (mean difference, −7.10 mm; 95% CI, −8.55 to −5.65; p < 0.001). Corresponding medians were 9.0 and 16.0 mm, and minima were 8.0 and 13.0 mm. The operative summary describes additional intraoperative resection in two conventional‐group patients following frozen‐section assessment. No statistically significant between‐group differences in perioperative outcomes were detected, but confidence intervals were wide. Final pathological margin assessment identified no positive margins in either group (ICG‐guided 0/15, 0.0%; conventional 0/15, 0.0%; Fisher's exact p = 1.000). The two intraoperative frozen‐section–positive events in the conventional group were resolved to negative final margins after same‐operation resection extension.
Conclusion
ICG fluorescence imaging was feasible in this small retrospective cohort and was associated with shorter recorded margin‐to‐tumor distances. These findings are hypothesis‐generating and do not establish improved oncologic margin control, perioperative equivalence or functional benefit. Larger prospective studies with standardized pathological assessment and adequate follow‐up are needed.