Chiba Naokazu, Shimazu Motohide, Ochiai Shigeto, Yokozuka Kei, Gunji Takahiro, Okihara Masaaki, Sano Toru, Tomita Koichi, Tsutsui Rina, Oshima Go, Takano Kiminori, Abe Yuta, Hirano Hiroshi, Kawachi Shigeyuki
Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi Hachioji, Tokyo, 193-0998, Japan.
Department of Surgery, Tama Kyuryo Hospital, 1491 Shimooyamada Machida, Tokyo, 194-0297, Japan.
World J Surg. 2019 Feb;43(2):608-614. doi: 10.1007/s00268-018-4810-8.
Various approaches to hepatectomy have been proposed for cT2 gallbladder cancers (GBC), but the optimal management strategy remains unclear. The aim of this study is to assess the effectiveness of using an indocyanine green (ICG)-based intraoperative navigation system during hepatic resection for cT2 GBC.
From September 2007 to December 2017, 24 consecutive patients diagnosed with cT2 GBC underwent hepatic resection using ICG navigation. After cannulation of the cholecystic artery, ICG diluted with dissolution liquid was injected and ICG fluorescence illumination was visualized with the HyperEye Medical System. And additional histopathological examination was performed on the most recent 15 of the 24 patients for detection of microscopic liver metastasis.
For all patients, the disease-free survival rate was 59.1% at 5 years and overall survival rate was 86.2% at 5 years. Microscopic liver metastasis was detected in the resected liver in 3 (20%) of 15 patients, whose site of liver was S6, S5, and S5, respectively. The weight of the liver resected using ICG navigation was significantly smaller than that of S4a/S5 segmentectomy (P < 0.0001).
Resected hepatic lesion using ICG imaging was possible to perform hepatectomy including liver micro-metastasis without excess or deficiency. This procedure might be novel intraoperative imaging method to provide valuable information on the optimal surgical approach to cT2 GBC.
对于cT2期胆囊癌（GBC），已经提出了多种肝切除方法，但最佳管理策略仍不明确。本研究的目的是评估在cT2期GBC肝切除术中使用基于吲哚菁绿（ICG）的术中导航系统的有效性。
2007年9月至2017年12月，24例连续诊断为cT2期GBC的患者接受了ICG导航下的肝切除术。在胆囊动脉插管后，注入用溶解液稀释的ICG，并用HyperEye Medical System观察ICG荧光照明。对24例患者中的最近15例进行了额外的组织病理学检查，以检测微小肝转移。
所有患者的5年无病生存率为59.1%，5年总生存率为86.2%。15例患者中有3例（20%）在切除的肝脏中检测到微小肝转移，其肝转移部位分别为S6、S5和S5。使用ICG导航切除的肝脏重量明显小于S4a/S5段切除术（P < 0.0001）。
使用ICG成像切除肝脏病变能够在不过度或不足的情况下进行包括肝微转移的肝切除术。该方法可能是一种新型的术中成像方法，可为cT2期GBC的最佳手术方法提供有价值的信息。
