Indocyanine Green-Fluorescent Pancreatic Perfusion-Guided Resection of Distal Pancreas in Solid Pseudopapillary Neoplasm: Usefulness and Feasibility During Pancreaticobiliary Surgery

Abstract

ICG is widely applied in real-time imaging during abdominal surgery, plastic surgery, as well as oncologic staging and treatment. A twenty-eight year-old female patient was found to have a 4.5 cm solid pseudopapillary neoplasm in the tail of the pancreas. Under ICG-fluorescent pancreatic perfusion-guidance, we easily defined the margin of the pancreatic tumor and secured the resection margin when performing laparoscopic distal pancreatosplenectomy in the patient. No clinically relevant complications, including postoperative pancreatic fistula, were noted. Intravenous ICG can be very easily and quickly detected in the pancreas under near infrared light. This enhanced vision gives strong contrast to the organ compared to a necrotic tumor with poor blood perfusion, such as solid pseudopapillary neoplasm. Based on our current experience, ICG pancreatic perfusion-guided determination of appropriate resection margin is useful and feasible during pancreaticoduodenectomy.

Current Advances in Photoactive Agents for Cancer Imaging and Therapy

“…Biopsies can be collected from the stained tumor for fluorescent histological analysis of specific tumor markers, allowing more precise diagnoses in order to determine appropriate treatment strategies (26). Indocyanine green (ICG) is commonly used for sentinel lymph node (SLN) mapping to detect metastasis, and it is also being assessed in clinical trials for improving complete surgical resection in pancreatic, breast, liver, and brain cancers (27)(28)(29)(30). This is termed photodynamic diagnostics and has also been applied in bladder cancer with Hexvix (an ALA analog) to identify masses that were initially missed by visual tumor identification during surgery (26).…”

Pitfalls for laparoscopic pancreaticoduodenectomy: Need for a stepwise approach

“…As a preliminary form of image‐guided surgery, intraoperative ICG can help in deciding whether to carry out minimally invasive pancreatectomy. Kim et al reported that, because the pancreas is a well‐vascularized organ, intravenous ICG will accumulate in the pancreas parenchyma. As such, they documented its usefulness in distal pancreatectomy to clearly define the appropriate margin of resection in a case of solid pseudopapillary neoplasm with poor uptake of ICG.…”