Doctors developed a new surgical technique that uses special glowing dye to help them see and remove rectal cancer more precisely while preserving the patient’s normal body functions. In this case study, a 72-year-old man with cancer very close to his anus underwent a minimally invasive surgery where surgeons injected fluorescent dye around the tumor to identify lymph nodes (small immune system glands) and checked blood flow to ensure proper healing. The surgery was successful, with minimal bleeding, quick recovery, and no complications. This technique combines two advanced technologies—fluorescence imaging and laparoscopic (camera-assisted) surgery—to give doctors better visibility during complex cancer removal procedures.

The Quick Take

  • What they studied: Whether surgeons could safely use a special glowing dye during minimally invasive surgery to remove cancer from the lowest part of the rectum while preserving normal body functions
  • Who participated: One 72-year-old male patient with early-stage rectal cancer located very close to the anus (4 cm away)
  • Key finding: The surgery successfully removed the cancer with excellent visibility of lymph nodes, good blood flow to the healing area, minimal blood loss (20 mL), quick recovery (discharged after 7 days), and no complications
  • What it means for you: This technique may offer rectal cancer patients a better option that preserves normal bowel and sexual function while ensuring thorough cancer removal, though this is based on one successful case and needs testing in more patients

The Research Details

This is a case report describing one patient’s surgical experience using a new combined technique. The surgeon used two types of fluorescent dye: one injected around the tumor 24 hours before surgery to help identify lymph nodes (the small glands that filter cancer cells), and another injected during surgery to check blood flow to the area where the bowel would be reconnected. The surgery was performed using laparoscopy, which means the surgeon used a camera and small instruments inserted through tiny cuts instead of one large incision.

The patient underwent what’s called an intersphincteric resection (ISR), which is a specialized technique for cancers very close to the anus. This approach aims to remove the cancer while keeping the sphincter muscles intact so the patient can maintain normal bowel control. The surgeons carefully documented the operation time, blood loss, lymph nodes removed, and recovery progress.

This research matters because rectal cancers located very close to the anus are extremely challenging to treat. Traditionally, surgeons had to remove the entire rectum and create a permanent colostomy (an opening in the abdomen for waste). This new technique combines advanced imaging technology to help surgeons see exactly where cancer cells and lymph nodes are located, potentially allowing them to remove less tissue while still ensuring complete cancer removal. Better visualization during surgery can reduce complications and improve patients’ quality of life.

This is a single case report, which is the lowest level of scientific evidence. It shows that the technique is possible and safe in one patient, but cannot prove it works for everyone. The patient had favorable characteristics (early-stage cancer, good health status, normal weight), so results may differ in other patients. The short follow-up time means we don’t yet know long-term outcomes. More studies with multiple patients are needed to confirm these promising results.

What the Results Show

The surgery was completed successfully in 215 minutes with only 20 mL of blood loss (about 1.3 tablespoons), which is remarkably low for this type of operation. The fluorescent dye worked as intended—it clearly highlighted the lymph nodes, allowing the surgeon to identify and remove 18 lymph nodes completely. The dye also confirmed that blood flow to the reconnected bowel was adequate, which is critical for proper healing.

The patient recovered quickly and well. He was able to drink fluids 2 days after surgery and was discharged from the hospital after 7 days. Most importantly, no surgical complications occurred—no infections, bleeding, or other problems developed. The final pathology report confirmed the cancer was completely removed with clear margins (no cancer cells at the edges).

At follow-up visits, the patient had no signs of cancer recurrence. Equally important, he maintained normal bowel control and sexual function, which are major quality-of-life concerns for rectal cancer patients. This suggests the surgery successfully preserved the sphincter muscles that control bowel function.

The pathological stage after surgery was T2N0M0, meaning the cancer had invaded the muscle layer but had not spread to lymph nodes or distant organs. This matched the pre-surgery imaging assessment. The patient did not require additional chemotherapy or radiation, which is typical for early-stage cancers with no lymph node involvement. The complete removal of the mesorectum (fatty tissue around the rectum containing lymph nodes) was confirmed, indicating thorough cancer removal.

Traditional surgery for ultralow rectal cancers often requires removing the entire rectum and creating a permanent colostomy, significantly impacting quality of life. Some recent studies have explored organ-preserving approaches like ISR, but this case is notable for combining ISR with fluorescence-guided imaging technology. The use of indocyanine green (ICG) dye for lymph node identification and blood flow assessment represents an advancement over standard techniques that rely solely on the surgeon’s visual inspection. This dual-application of fluorescence imaging appears to be a novel combination not widely reported in the literature.

This is a single case report with one patient, so we cannot generalize these results to all patients with ultralow rectal cancer. The patient had favorable characteristics (early-stage cancer, good overall health, normal weight, no other medical conditions) that may have contributed to the excellent outcome. The follow-up period appears relatively short—we don’t know about long-term outcomes beyond the initial recovery period. The technique requires specialized equipment and surgeon expertise, so it may not be available at all hospitals. Different patients with different tumor characteristics, health conditions, or body types may have different results. More research with larger groups of patients is essential before this becomes standard treatment.

The Bottom Line

Based on this single case, fluorescence-guided laparoscopic-assisted intersphincteric resection appears to be a safe and effective option for selected patients with ultralow rectal cancer who are candidates for organ-preserving surgery. However, this technique should currently be considered experimental and should only be performed by experienced colorectal surgeons at specialized cancer centers. Patients interested in this approach should discuss it with their oncology team to determine if they are suitable candidates. The evidence level is low (single case report), so patients should understand this is a promising new technique that requires further study.

This research is most relevant to patients with rectal cancer located very close to the anus who want to avoid a permanent colostomy and preserve normal bowel and sexual function. It may be of interest to colorectal surgeons and oncologists seeking advanced surgical techniques. Patients with early-stage rectal cancer (stages I-II) are more likely to be candidates than those with advanced disease. However, patients with very advanced cancer, poor overall health, or significant obesity may not be suitable candidates. General readers should understand this is specialized research for a specific patient population and does not apply to most people.

In this case, the patient experienced rapid recovery with discharge 7 days after surgery and quick return to normal diet. However, full recovery from major abdominal surgery typically takes 4-6 weeks. The patient maintained normal bowel and sexual function immediately after surgery, which is encouraging. Long-term outcomes (5-year survival and recurrence rates) cannot be assessed from this single case and would require years of follow-up.

Want to Apply This Research?

  • For patients undergoing this procedure, track daily bowel function (frequency, consistency, urgency) and any leakage episodes using a simple 1-10 scale to monitor sphincter recovery and function over the first 3 months post-surgery
  • Post-operative patients can use the app to log dietary tolerance (which foods cause discomfort), pain levels, and activity levels to optimize recovery and identify when they can return to normal activities
  • Establish a long-term tracking system for cancer surveillance markers, follow-up appointment reminders, and quality-of-life metrics (bowel function, sexual function, overall satisfaction) to monitor for recurrence and assess surgical success over years

This case report describes a single patient’s surgical experience and should not be considered definitive evidence that this technique is appropriate for all rectal cancer patients. Results may vary significantly based on individual factors including cancer stage, patient health status, surgeon experience, and hospital resources. This research is preliminary and requires further study with larger patient populations before becoming standard treatment. Patients with rectal cancer should discuss all treatment options, including this emerging technique, with their oncology team. This information is for educational purposes only and should not replace professional medical advice from qualified healthcare providers. Always consult with your doctor before making treatment decisions.