Department of Paediatric Surgery and Urology, Birmingham Women's, and Children's NHS Foundation Trust, UK.
Department of Paediatric Surgery and Urology, Birmingham Women's, and Children's NHS Foundation Trust, UK; Cancer Research UK Clinical Trials Unit, Institute of Cancer and Genomic Sciences, University of Birmingham, UK.
Photodiagnosis Photodyn Ther. 2023 Jun;42:103639. doi: 10.1016/j.pdpdt.2023.103639. Epub 2023 May 27.
Indocyanine green (ICG) fluoresces in the near infra-red (NIR) spectrum. It is widely used in adult oncological surgery for identification of tumor margins and lymph node sampling. However, deliver of ICG in almost all studies is 24 h or more prior to surgery. This is the first study in children to assess its feasibility in minimally invasive surgery (MIS) for oncological disease following ICG injection during induction of anesthesia.
This was an open label, prospective, single center, feasibility study recruiting consecutive patients eligible for MIS tumor resection or metastectomy. ICG was injected intravenously at induction of anesthesia. Patient demographics, intraoperative appearances, post-operative histopathology, and surgeon Likert ratings were collected.
Fourteen patients were included. Five had lung metastases (Wilms, Osteosarcoma (2), Hodgkin's, melanoma) and 9 had other tumors (neuroblastoma, inflammatory myofibroblastic tumor, ganglioneuroma, phaeochromocytoma, adrenal tumor). Lung metastases were easily identifiable, and all had negative margins. Tumors containing viable disease fluoresced and were completely resected, whilst benign and heavily treated tumors were afluorescent. There were no adverse events relating to ICG or issues with background fluorescence.
Based on this small sample, injection of ICG during induction of anesthesia is safe and effective in showing tumor margins in patients who have had little or no neoadjuvant chemotherapy as well as in metastectomy in Wilms and osteosarcoma. Further studies are needed to confirm these preliminary results.
吲哚菁绿（ICG）在近红外（NIR）光谱下发出荧光。它在成人肿瘤外科中被广泛用于识别肿瘤边界和淋巴结取样。然而，在几乎所有研究中，ICG 的给药时间都是在手术前 24 小时或更长时间。这是第一项在儿童中评估其在麻醉诱导期间静脉注射 ICG 后进行微创外科（MIS）治疗肿瘤疾病的可行性的研究。
这是一项开放标签、前瞻性、单中心、可行性研究，招募了符合 MIS 肿瘤切除术或转移切除术条件的连续患者。在麻醉诱导时静脉注射 ICG。收集患者的人口统计学资料、术中表现、术后组织病理学和外科医生 Likert 评分。
共纳入 14 例患者。5 例为肺转移瘤（Wilms、骨肉瘤（2 例）、霍奇金淋巴瘤、黑色素瘤），9 例为其他肿瘤（神经母细胞瘤、炎性肌纤维母细胞瘤、神经节细胞瘤、嗜铬细胞瘤、肾上腺肿瘤）。肺转移瘤很容易识别，且均为阴性边界。含有存活肿瘤的肿瘤发出荧光并被完全切除，而良性和经大量治疗的肿瘤则无荧光。与 ICG 或背景荧光无关的不良事件。
基于这个小样本，麻醉诱导期间注射 ICG 对于接受过很少或没有新辅助化疗的患者以及在 Wilms 和骨肉瘤中进行转移切除术的患者，安全且有效地显示肿瘤边界。需要进一步的研究来证实这些初步结果。
