Wang Jiaguo, Xu Jie, Yuan Jingsheng, Wu Jun, Dong Jiahong, Yang Jiayin
Liver Transplant Center, Department of General Surgery, West China Hospital of Sichuan University, Chengdu, China.
Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Surg Endosc. 2025 Jul 8. doi: 10.1007/s00464-025-11869-0.
Increased emphasis has been placed on the accurate assessment of the number and location of colorectal liver metastases (CRLMs), as well as on the implementation of more flexible and efficient surgical strategies for diverse lesions. This study aimed to evaluate the advantages of near-infrared fluorescence imaging (NIRF) combined with a Sonazoid contrast-enhanced ultrasound (SCEUS)-guided laparoscopic surgical strategy for CRLMs.
This article details the comprehensive process of CRLM detection and the surgical approach for various lesions. Additionally, a retrospective analysis of clinical data from 69 patients with CRLM at two Chinese centers between December 2022 and May 2024 was conducted. Statistical comparisons were performed using paired t tests to evaluate the number of lesions detected across multiple imaging modalities. Perioperative short-term outcomes and oncological results were evaluated.
In all, 271 lesions were identified using preoperative EOB-MRI+CT as the reference standard. WL+IOUS and NIRF+SCEUS detected 234 and 285 lesions, respectively. Paired t test analysis revealed that the detection rate of lesions by WL+IOUS was significantly lower than that by EOB-MRI+CT (3.391 vs 3.942, P < 0.01), the detection rate with NIRF+SCEUS was substantially greater than that with WL+IOUS (4.130 vs 3.391, P < 0.01), as, NIRF+SCEUS identified 5/12 "disappearing" lesions (3 NIRF+, 2 SCEUS+) following neoadjuvant therapy, 25 lesions were also detected preoperatively by NIRF+SCEUS but not by WL+IOUS (16 NIRF+, 9 SCEUS+), and an additional 21 lesions were not detected preoperatively (11 NIRF+, 10 SCEUS+). The utilization of NIRF+SCEU resulted in changes to the surgical strategy in 28 patients (40.6%). Intraoperative and postoperative outcomes revealed 6 cases of iatrogenic tumor rupture, 67 cases of R0 resection, 3 cases with Clavien III-IV complications, and no 90-day mortality.
NIRF+SCEUS not only improves the number of lesions detected by laparoscopy but also guides the resection of lesions and increases the R0 resection rate. This surgical strategy does not increase postoperative complications or mortality.
目前越来越强调对结直肠癌肝转移（CRLMs）的数量和位置进行准确评估，以及针对不同病变实施更灵活、高效的手术策略。本研究旨在评估近红外荧光成像（NIRF）联合声诺维增强超声（SCEUS）引导的腹腔镜手术策略对CRLMs的优势。
本文详细介绍了CRLMs检测的综合过程以及针对各种病变的手术方法。此外，对2022年12月至2024年5月期间中国两个中心的69例CRLMs患者的临床资料进行了回顾性分析。使用配对t检验进行统计比较，以评估多种成像方式检测到的病变数量。评估围手术期短期结局和肿瘤学结果。
以术前EOB-MRI+CT作为参考标准，共识别出271个病变。白光成像（WL）+术中超声（IOUS）和NIRF+SCEUS分别检测到234个和285个病变。配对t检验分析显示，WL+IOUS对病变的检测率显著低于EOB-MRI+CT（3.391对3.942，P<0.01），NIRF+SCEUS的检测率显著高于WL+IOUS（4.130对3.391，P<0.01），因为NIRF+SCEUS在新辅助治疗后识别出5/12个“消失”病变（3个NIRF阳性，2个SCEUS阳性），术前NIRF+SCEUS还检测到25个WL+IOUS未检测到的病变（16个NIRF阳性，9个SCEUS阳性），另外还有21个病变术前未被检测到（11个NIRF阳性，10个SCEUS阳性）。NIRF+SCEU的应用导致28例患者（40.6%）的手术策略发生改变。术中和术后结果显示有6例医源性肿瘤破裂，67例R0切除，3例出现Clavien III-IV级并发症，无90天死亡率。
NIRF+SCEUS不仅提高了腹腔镜检测到的病变数量，还指导了病变切除并提高了R0切除率。这种手术策略不会增加术后并发症或死亡率。
