Indocyanine green fluorescence navigation for hepatocellular carcinoma with bile duct tumor thrombus: a case report

Abstract

Background Bile duct tumor thrombus (BDTT) is one of the features of advanced hepatocellular carcinoma (HCC). In the resection of HCC with BDTT, it is important to detect the BDTT tip to decide the appropriate point of bile duct division. In this regard, the efficacy of indocyanine green (ICG) fluorescence navigation has been confirmed for the detection of HCC, whereas its utility for BDTT has not yet been reported. Herein, we describe our experience with right hepatectomy for HCC with BDTT using ICG fluorescence navigation. Case presentation A 72-year-old woman had experienced local recurrences of HCC after radiofrequency ablation, with BDTT reaching the confluence of the right anterior branch and posterior branch. Right hepatectomy was planned, and 2.5 mg of ICG was injected one day before surgery. After transection of the liver parenchyma, the right liver was connected with only the right hepatic duct. ICG fluorescence imaging visualized the tip of BDTT in the bile duct with clear contrast; the proximal side (hepatic side) of the right hepatic duct showed stronger fluorescence than the distal side (duodenal side). The bile duct was divided at the distal side of the BDTT border, and the tip of BDTT was recognized into the resected right hepatic duct without laceration. The patient had an uneventful postoperative course and currently lives without recurrences for 6 months. Conclusions ICG fluorescence navigation assisted in the precise resection of the bile duct in HCC with BDTT.

Indocyanine Green Fluorescence Navigation in Liver Surgery

“…When combined with preoperative 3D reconstruction and IOUS, it can be solid real-time navigation tool to make a huge difference in accuracy of liver resections. However, best time point and dose of ICG administration for tumor identification and liver segmentation remains unclear due to various patient backgrounds and imaging settings in the previous studies 56–101 . Thus, its administration strongly needs to be tailored case by case in daily practice.…”

Targeting Contrast Agents With Peak Near-Infrared-II (NIR-II) Fluorescence Emission for Non-invasive Real-Time Direct Visualization of Thrombosis

“…1-10 mm) that NIR-I light affords as a result of it incurring both less photon absorption in tissue and scattering by biomolecules (e.g., hemoglobin) compared to fluorophores that provide peak fluorescence emission at wavelengths within the visible light spectrum (Vis, ca. 405-700 nm) (Frenette et al, 1995;Jaffer Farouc et al, 2002;Frangioni, 2003;Tung et al, 2003;Kim et al, 2005;Robert et al, 2007;Hara et al, 2012;Diao et al, 2015;Page et al, 2015;Vargas et al, 2015;Gerstenhaber et al, 2017;Lim et al, 2017;Kwon et al, 2018;Vankayala et al, 2018;Zhang et al, 2018;He et al, 2019;Lee et al, 2019;Yusof et al, 2019;Wan et al, 2020;Zhao Y. et al, 2020;Matsumura et al, 2021). The most recent advancement in the NIRF imaging of thrombosis and its sequelae is the development of contrast agents that provide peak fluorescence emission within the NIR-II optical window (NIR-II, ca.…”