Piccolo Gaetano, Barabino Matteo, Ghilardi Giorgio, Masserano Riccardo, Lecchi Francesca, Piozzi Guglielmo Niccolò, Bianchi Paolo Pietro
General Surgery Unit, Department of Health Sciences (DISS), San Paolo Hospital, University of Milan, 20142 Milano, Italy.
Department of Colorectal Surgery, Portsmouth Hospitals University NHS Trust, Portsmouth PO6 3LY, UK.
Cancers (Basel). 2024 Apr 24;16(9):1641. doi: 10.3390/cancers16091641.
The European Association of Endoscopic Surgery (EAES) recommends, with strong evidence, the use of indocyanine green (ICG) fluorescence imaging combined with intraoperative ultrasound (IOUS) to improve identification of superficial liver tumors. This study reports the use of ICG for the detection of colorectal liver metastases (CRLMs) during minimally invasive liver resection.
A single-center consecutive series of minimally invasive (laparoscopic and robotic) hepatic resections for CRLMs was prospectively evaluated (April 2019 and October 2023).
A total of 25 patients were enrolled-11 undergoing laparoscopic and 14 undergoing robotic procedures. The median age was 65 (range 50-85) years. Fifty CRLMs were detected: twenty superficial, eight exophytic, seven shallow (<8 mm from the hepatic surface), and fifteen deep (>10 mm from the hepatic surface) lesions. The detection rates of CRLMs through preoperative imaging, laparoscopic ultrasound (LUS), ICG fluorescence, and combined modalities (ICG and LUS) were 88%, 90%, 68%, and 100%, respectively. ICG fluorescence staining allowed us to detect five small additional superficial lesions (not identified with other preoperative/intraoperative techniques). However, two lesions were false positive fluorescence accumulations. All rim fluorescence pattern lesions were CRLMs. ICG fluorescence was used as a real-time guide to assess surgical margins during parenchymal-sparing liver resections. All patients with integrity of the fluorescent rim around the CRLM displayed a radical resection during histopathological analysis. Four patients (8%) with a protruding rim or residual rim patterns had positive resection margins.
ICG fluorescence imaging can be integrated with other conventional intraoperative imaging techniques to optimize intraoperative staging. Rim fluorescence proved to be a valid indicator of the resection margins: by removing the entire fluorescent area, a tumor-negative resection (R0) is achieved.
欧洲内镜外科学会（EAES）有充分证据推荐使用吲哚菁绿（ICG）荧光成像联合术中超声（IOUS）来提高浅表肝脏肿瘤的识别。本研究报告了ICG在微创肝切除术中用于检测结直肠癌肝转移（CRLM）的情况。
对2019年4月至2023年10月期间单中心连续进行的CRLM微创（腹腔镜和机器人辅助）肝切除术进行前瞻性评估。
共纳入25例患者，其中11例接受腹腔镜手术，14例接受机器人辅助手术。中位年龄为65岁（范围50 - 85岁）。共检测到50个CRLM：20个浅表性、8个外生性、7个浅层（距肝表面<8 mm）和15个深层（距肝表面>10 mm）病变。通过术前成像、腹腔镜超声（LUS）、ICG荧光和联合模式（ICG和LUS）检测CRLM的比率分别为88%、90%、68%和100%。ICG荧光染色使我们能够检测到另外5个小的浅表病变（其他术前/术中技术未识别）。然而，有2个病变为荧光假阳性积聚。所有边缘荧光模式病变均为CRLM。在保留肝实质的肝切除术中，ICG荧光被用作评估手术切缘的实时引导。所有CRLM周围荧光边缘完整的患者在组织病理学分析中均显示为根治性切除。4例（8%）边缘突出或有残留边缘模式的患者切缘阳性。
ICG荧光成像可与其他传统术中成像技术相结合，以优化术中分期。边缘荧光被证明是手术切缘的有效指标：通过切除整个荧光区域，可实现肿瘤阴性切除（R0）。
