Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Surgical Oncology Program, Texas Children's Liver Tumor Program, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX USA.
Department of Pathology and Immunology, Texas Children's Hospital Liver Tumor Center, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX USA.
J Pediatr Surg. 2022 Apr;57(4):700-710. doi: 10.1016/j.jpedsurg.2021.04.019. Epub 2021 Apr 25.
Hepatoblastoma (HB) and hepatocellular carcinoma (HCC) are the most common primary malignant tumors of childhood. Intraoperative indocyanine green (ICG) administration with near-infrared imaging (NIR) has emerged as a surgical technology that can be used to assist with localization of pulmonary metastases secondary to HB; however, there has been limited application as an adjunct for resection of the primary liver tumor and assessment of extrahepatic disease.
We present 14 patients treated for HB, HCC, and malignant rhabdoid tumor at our institution with the use of intraoperative NIR-ICG guidance. All patients were treated with 0.2-0.75 mg/kg IV ICG, 48-96 h prior to surgery. Intraoperative NIR-ICG guided imaging was performed with several commercial devices.
Intraoperative NIR-ICG guidance allowed pulmonary metastasectomy in five patients using thoracoscopy or thoracotomy allowing for visualization of multiple nodules not seen on preoperative imaging most of which were positive for malignancy. NIR-ICG guidance allowed for assessment of extrahepatic extension in three patients; an HCC patient with extrahepatic lymph node extension of disease, an HB patient with extrapulmonary thoracic recurrence in the diaphragm and chest wall, and a patient with tumor rupture at diagnosis with peritoneal nodules at the time of surgery. This technique was used to guide partial hepatectomy in 11 patients for which the technique enabled successful identification of tumor and tumor margins. Three patients had nonspecific staining of the liver secondary to decreased timing from ICG injection to surgery or biliary obstruction. NIR-ICG enabled resection of satellite HB lesions in three multifocal patients and confirmed a benign satellite lesion in two additional patients.
Intraoperative use of NIR-ICG imaging during partial hepatectomy enabled enhanced identification and guidance for surgical resection of extrahepatic disease and multifocal liver tumors for the treatment of children with primary liver cancer.
肝母细胞瘤 (HB) 和肝细胞癌 (HCC) 是儿童最常见的原发性恶性肿瘤。术中吲哚菁绿 (ICG) 给药联合近红外成像 (NIR) 已成为一种外科技术，可用于辅助定位 HB 继发的肺转移；然而，作为辅助切除原发性肝肿瘤和评估肝外疾病的应用有限。
我们在本机构对 14 例 HB、HCC 和恶性横纹肌样瘤患者使用术中 NIR-ICG 引导进行治疗。所有患者均在术前 48-96 小时内接受 0.2-0.75mg/kg IV ICG 治疗。术中使用几种商业设备进行 NIR-ICG 引导成像。
术中 NIR-ICG 引导使五例患者能够通过胸腔镜或开胸术进行肺转移切除术，从而可以观察到术前影像学检查未发现的多个结节，其中大多数为恶性结节。NIR-ICG 引导使三名患者能够评估肝外延伸情况；一名 HCC 患者有肝外淋巴结转移，一名 HB 患者有肺外胸壁和膈肌复发，一名患者在诊断时发生肿瘤破裂，手术时腹腔内有结节。该技术用于指导 11 例患者进行部分肝切除术，该技术成功识别肿瘤和肿瘤边界。三名患者因 ICG 注射到手术的时间间隔缩短或胆道阻塞而出现肝脏非特异性染色。NIR-ICG 使三名多灶性患者的卫星 HB 病变得以切除，并在另外两名患者中证实了良性卫星病变。
在部分肝切除术中使用 NIR-ICG 成像可增强对肝外疾病和多灶性肝肿瘤的识别和指导，从而为治疗原发性肝癌的儿童提供帮助。
