Handgraaf H J M, Boogerd L S F, Höppener D J, Peloso A, Sibinga Mulder B G, Hoogstins C E S, Hartgrink H H, van de Velde C J H, Mieog J S D, Swijnenburg R J, Putter H, Maestri M, Braat A E, Frangioni J V, Vahrmeijer A L
Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
Department of Medical and Surgical Sciences, University of Pavia, Foundation IRCCS Policlinico San Matteo Hospital, Pavia, Italy.
Eur J Surg Oncol. 2017 Aug;43(8):1463-1471. doi: 10.1016/j.ejso.2017.04.016. Epub 2017 May 6.
Several studies demonstrated that intraoperative near-infrared fluorescence (NIRF) imaging using indocyanine green (ICG) identifies (sub)capsular colorectal liver metastases (CRLM) missed by other techniques. It is unclear if this results in any survival benefit. This study evaluates long-term follow-up after NIRF-guided resection of CRLM using ICG.
First, patients undergoing resection of CRLM with or without NIRF imaging were analyzed retrospectively. Perioperative details, liver-specific recurrence-free interval and overall survival were compared. Second, the prognosis of patients in whom additional metastases were identified solely by NIRF was studied.
Eighty-six patients underwent resection with NIRF imaging and 87 without. In significantly more patients of the NIRF imaging cohort additional metastases were identified during surgery (25% vs. 13%, p = 0.04). Tumors identified solely by NIRF imaging were significantly smaller compared to additional metastases identified also by inspection, palpation or intraoperative ultrasound (3.2 ± 1.8 mm vs. 7.4 ± 2.6 mm, p < 0.001). Liver-specific recurrence-free survival at 4 years was 47% with NIRF imaging and 39% without (hazard ratio at multivariate analysis 0.73, 95% CI 0.42-1.28, p = 0.28). Overall survival at 4 years was 62% and 59%, respectively (p = 0.79). No liver recurrences occurred within 3 years follow-up in 52% of patients in whom additional metastases were resected based on only NIRF imaging.
This study suggests that NIRF imaging identifies significantly more and smaller tumors during resection of CRLM, preventing recurrences in a subset of patients. Given its safety profile and low expense, routine use can be considered until tumor targeting fluorescent tracers are clinically available.
多项研究表明，使用吲哚菁绿（ICG）的术中近红外荧光（NIRF）成像可识别出其他技术遗漏的（亚）包膜下结直肠癌肝转移（CRLM）。目前尚不清楚这是否能带来生存获益。本研究评估了使用ICG进行NIRF引导下CRLM切除术后的长期随访情况。
首先，对接受或未接受NIRF成像的CRLM切除术患者进行回顾性分析。比较围手术期细节、肝脏特异性无复发生存期和总生存期。其次，研究仅通过NIRF识别出额外转移灶的患者的预后。
86例患者接受了NIRF成像下的切除术，87例未接受。在NIRF成像队列中，术中发现额外转移灶的患者明显更多（25%对13%，p = 0.04）。与通过检查、触诊或术中超声也能发现的额外转移灶相比，仅通过NIRF成像发现的肿瘤明显更小（3.2±1.8毫米对7.4±2.6毫米，p < 0.001）。接受NIRF成像的患者4年肝脏特异性无复发生存率为47%，未接受的为39%（多因素分析风险比为0.73，95%置信区间为0.42 - 1.28，p = 0.28）。4年总生存率分别为62%和59%（p = 0.79）。在仅基于NIRF成像切除额外转移灶的患者中，52%在3年随访期内未发生肝脏复发。
本研究表明，NIRF成像在CRLM切除术中能发现明显更多且更小的肿瘤，可预防部分患者复发。鉴于其安全性和低成本，在肿瘤靶向荧光示踪剂临床可用之前可考虑常规使用。
