Indocyanine green fluorescence-navigated laparoscopic metastasectomy for peritoneal metastasis of hepatocellular carcinoma: a case report

Abstract

BackgroundIndocyanine green (ICG) can selectively accumulate in primary hepatocellular carcinoma (HCC) and its extrahepatic metastases. ICG fluorescence imaging is an extremely sensitive intraoperative tool for detecting HCC foci and can be used to detect impalpable tumors in laparoscopic surgery. Here, we report a case of a 75-year-old man who underwent peritoneal metastasis resection of HCC using a laparoscopic near-infrared imaging system and ICG fluorescence-navigated surgery.Case presentationA 75-year-old man was referred to our department for peritoneal metastasis resection of HCC. Two years before admission, he had undergone transarterial embolization and segmentectomy of segment 6 with open surgery for ruptured HCC. Computed tomography revealed a 12-mm peritoneal metastatic lesion on the abdominal wall near the cut surface of the liver. No other metastases were observed; resection of the solitary metastasis was scheduled. ICG (0.5 mg/kg body weight) was intravenously injected, 72 h preoperatively. An endoscopic, ICG near-infrared fluorescence imaging system revealed clear green fluorescence, indicating peritoneal metastasis of HCC on the abdominal wall. The tumor was resected with adequate surgical margin by partially resecting the liver and diaphragm, followed by histological confirmation as peritoneal metastasis of HCC. No recurrence was observed after 12 months of follow-up.ConclusionsICG fluorescence can be useful in laparoscopic surgery for identifying peritoneal metastasis.

Indocyanine green fluorescence-guided intraoperative detection of peritoneal carcinomatosis: systematic review

“…All the series were published in the period 2015-2018. A case report including only 1 patient with peritoneal recurrence of ruptured HCC was analyzed and excluded, according to selection criteria [6]. One series was further not analyzed because the primary outcome was liver metastases detection [7].…”

“…In case of HCC the timing is different, as ICG is metabolized by normal hepatocytes and unexcreted because of bile ducts alteration, elightening the nodules even many days after the injection. In the case report of peritoneal implant of previously ruptured HCC excluded from the present systematic review, injection of 0,5 mg/kg ICG was performed 72 h before surgery [6]. From a dosing point of view, virtually all series carry the same dosage (0.25 mg/kg), except one that carries twice and one that uses a fixed dose independently from weight (20 mg).…”

Indocyanine Green Fluorescence-Guided Intraoperative Detection of Peritoneal Carcinomatosis: Systematic Review.

“…All the series were published in the period 2015-2018. A case report including 1 only patient with peritoneal recurrence of ruptured HCC was analyzed and excluded, according to selection criteria [6]. One series was further not analyzed because the primary outcome was liver metastases detection [7].…”

“…Indeed, papers reporting the usefulness of ICG in liver surgery always report intravenous injection from 1 to several days before surgery [20]. In the case report of peritoneal implant of previously ruptured HCC excluded from the present systematic review, injection of 0,5 mg/kg ICG was performed 72 h before surgery [6]. From a dosing point of view, virtually all series carry the same dosage (0.25 mg/kg), except one that carries twice and one that uses a fixed dose independently from weight (20 mg).…”

Indocyanine Green Fluorescence-guided intraoperative detection of peritoneal carcinomatosis: systematic review.

“…In case of HCC the timing is different, as ICG is metabolized by normal hepatocytes and unexcreted because of bile ducts alteration, elightening the nodules even many days after the injection. In the case report of peritoneal implant of previously ruptured HCC excluded from the present systematic review, injection of 0,5 mg/kg ICG was performed 72 h before surgery [6]. From a dosing point of view, virtually all series carry the same dosage (0.25 mg/kg), except one that carries twice and one that uses a xed dose independently from weight (20 mg).…”