Does Using Indocyanine Green Fluorescence Imaging for Tumors Help in Determining the Safe Surgical Margin in Real-Time Navigation of Laparoscopic Hepatectomy? A Retrospective Study

Abstract

Background This study aims to investigate whether indocyanine green (ICG) tumor imaging helps determine the safe surgical margin in laparoscopic hepatectomy. Patients and Methods Eighty-six patients with hepatic malignancies [including hepatocellular carcinoma (HCC) and colorectal liver metastasis (CRLM)] were included in this study. ICG-R15 testing was performed 5–7 days before surgery. Fluorescence staining of the tumor was detected by a fluorescent laparoscope, and the width of fluorescence band surrounding tumor was measured by an electronic vernier caliper. Results The positive rate of hepatic malignant lesions successfully stained by ICG fluorescence was 96.0% (95/99). HCC with better differentiation demonstrated non-rim fluorescence patterns, while cases with poor differentiation demonstrated rim patterns. CRLM uniformly demonstrated rim pattern. The width of fluorescence surrounding tumors was 0 in HCC with non-rim patterns. The minimum width of fluorescence surrounding tumors in poor differentiated HCC and CRLM were 2.4 ± 1.9 mm and 2.8 ± 2.5 mm, respectively, with no significant difference (P > 0.05). ICG fluorescence imaging revealed eight small lesions, which were not detected preoperatively in seven patients, of which five lesions were confirmed as malignancies by pathology. Conclusions Resection along the ICG fluorescence edge can supply a safe surgical margin only for CRLM, but not for HCC. Otherwise, ICG fluorescence tumor imaging can preliminarily determine the pathological type of hepatic malignancies and histological differentiation of HCC and help detect small lesions that cannot be detected preoperatively.

Perioperative and Recurrence-Free Survival Outcomes after Laparoscopic Hepatectomy for Colorectal Cancer Liver Metastases Using Indocyanine Green Fluorescence Imaging: A Single-Center Experience

“…The basic principle of surgical treatment is to achieve a negative resection margin for most liver malignant tumors. Cai 20 reported that the median width of uorescence surrounding tumors in CRLM was 2.8mm measured with an electronic vernier caliper. For CRLM, it is currently widely accepted that a 1-mm margin is considered adequate based on oncological principles 21 .…”

Surgical Margin of Resected Colorectal Liver Metastases

“…Studies out of Japan and China have investigated the use of preoperatively administered indocyanine green (ICG) to facilitate resection of CRLM 20,21 . Although these studies have demonstrated that ICG can aid in identifying CRLM intraoperatively and in obtaining a negative margin, the median fluorescent rim around the resected lesions in these studies was not reliably wide, with ~20% <1 mm.…”

Application of a self-developed, low-budget indocyanine green camera in surgical imaging – a single institution's experiences

“…The part of the liver to be resected is excluded from the circulation even before the administration of ICG, and thus the part of the liver perfused and not perfused with ICG becomes clearly visible, i.e. the resection border [4]. In our own operation, a 54-year-old male patient operated on for hepatocellular carcinoma was given 25 mg of ICG intravenously the day before the operation, according to literature data.…”