Intra-arterial versus negative-staining of embryonal resection borders with indocyanine green (ICG) fluorescence for total mesorectal excision in colorectal cancer – an experimental feasibility study in a porcine model

Frank, A.; Heiliger, Christian; Andrade, Dorian; Werner, J. A.; Karcz, Konrad

doi:10.1080/13645706.2020.1762655

Cited by 5 publications

(5 citation statements)

References 15 publications

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“…In previous experiments 1 , 2 , a rapid ICG washout was observed with intra-arterial administration, so the experiments were performed with continuous administration. Forgione et al have investigated this both quantitatively and qualitatively and have come to the results here of an optimal infusion rate of 20 ml/h with a dosage of 0.01 mg/kg 3 .…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic intraarterial catheterization with selective ICG fluorescence imaging in colorectal surgery

Heiliger

Piecuch

Frank

et al. 2021

Sci Rep

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The quality of mesorectal resection is crucial for resection in rectal cancer, which should be performed by laparoscopy for better outcome. The use of indocyanine green (ICG) fluorescence is now routinely used in some centers to evaluate bowel perfusion. Previous studies have demonstrated in animal models that selective intra-arterial ICG staining can be used to define and visualize resection margins in rectal cancer. In this animal study, we investigate if laparoscopic intra-arterial catheterization is feasible and the staining of resection margins when performing total mesorectal excision with a laparoscopic medial to lateral approach is possible. In 4 pigs, laparoscopic catheterization of the inferior mesenteric artery (IMA) is performed using a seldinger technique. After a bolus injection of 10 ml ICG with a concentration of 0.25 mg/ml, a continuous intra-arterial perfusion was established at a rate of 2 ml/min. The quality of the staining was evaluated qualitatively. Laparoscopic catheterization was possible in all cases, and the average time for this was 30.25 ± 3.54 min. We observed a significant fluorescent signal in all areas of the IMA supplied, but not in other parts of the abdominal cavity or organs. In addition, the mesorectum showed a sharp border between stained and unstained tissue. Intraoperative isolated fluorescence augmentation of the rectum, including the mesorectum by laparoscopic catheterization, is feasible. Inferior mesenteric artery catheterization and ICG perfusion can provide a fluorescence-guided roadmap to identify the correct plane in total mesorectal excision, which should be investigated in further studies.

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Section: Discussionmentioning

confidence: 99%

Laparoscopic intraarterial catheterization with selective ICG fluorescence imaging in colorectal surgery

Heiliger

Piecuch

Frank

et al. 2021

Sci Rep

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“…Intraoperative near-infrared fluorescence imaging with the use of ICG as a fluorophore is an increasingly performed technique: for organ perfusion, anatomy identification and also for mapping of lymphatic drainage [27,28]. NIRF has been shown to allow SLN detection in colorectal specimens in both in vivo and ex vivo settings.…”

Section: Discussionmentioning

confidence: 99%

Upstaging nodal status in colorectal cancer using ex vivo fluorescence sentinel lymph node mapping: preliminary results

Picchetto

Diana

Swanström

et al. 2020

Minimally Invasive Therapy & Allied Technologies

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Background: Sentinel lymph node (SLN) mapping using near-infrared fluorescence (NIRF) imaging is a recent technique to improve nodal staging in several tumors. The presence of colorectal cancer (CRC) micro-metastases has recently been defined as N1 disease and no longer as N1mi, determining the need for adjuvant chemotherapy. In CRC, the reported rate of SLN micro-metastases detected by ultrastaging techniques is as high as 30%. The aim of this prospective study is to report the preliminary results of the sensitivity analysis of NIRF imaging for ex vivo SLN mapping and the research of micro-metastases in CRC, in patients with node-negative disease (NND). Material and methods: On the specimen of 22 CRC patients, 1 mL of ICG (5 mg/mL) was injected submucosally around the tumor to identify SLNs. NND SLNs were further investigated with ultrastaging techniques. Results: Three-hundred and sixty-three lymph nodes were retrieved (59 SLNs; mean per case: 2.7). The detection, sensitivity and false-negative rate were 100%, 100% and 0% respectively. Ultrastaging investigations showed no micro-metastases in the NND SLNs. Conclusions: The ex vivo SLN fluorescence-based detection in CRC was confirmed to be easy to perform and reliable. In this preliminary results report of an ongoing study, the SLN assay was congruent with the nodal status, as confirmed by histological investigations.

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“…Frank et al 57 compared intra-arterial infusion of ICG selectively through the IMA and negative ICG imaging via systemic intravenous ICG infusion after the complete ligation of the IMA and of the inferior mesenteric vein (IMV) in an experimental study in a porcine model. Clear resection margins were defined after intra-arterial infusion, and all tissues in the IMA basin were colored.…”

Section: Methodsmentioning

confidence: 99%

“…Arezzo et al developed a meta-analysis in nearly 1,330 patients with AL at 4.2% with ICG vs. 11.3% without ICG [56]. They concluded that the greatest benefit from ICG can be found in men, ≥65 years of age, BMI ≥25, ≤6cm from the anal edge.…”

Section: Vascular Imagingmentioning

confidence: 99%

Fluorescence Imaging in Colorectal Surgery: An Updated Review and Future Trends

et al. 2022

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Fluorescence imaging in colorectal surgery is considered a novel predominantly intraoperative method of ensuring a greater surgical success. The use of fluorescence is linked to advanced tumor visualization and projection of its lymphatics, both vessels and nodes, which results in a higher chance of achieving a total excision. Additionally, iatrogenic complications prove to be reduced using fluorescence during the surgical excision. The combination of fluorescence and artificial intelligence to better facilitate oncological surgery will soon become an established approach in operating rooms worldwide.

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Intra-arterial versus negative-staining of embryonal resection borders with indocyanine green (ICG) fluorescence for total mesorectal excision in colorectal cancer – an experimental feasibility study in a porcine model

Cited by 5 publications

References 15 publications

Laparoscopic intraarterial catheterization with selective ICG fluorescence imaging in colorectal surgery

Laparoscopic intraarterial catheterization with selective ICG fluorescence imaging in colorectal surgery

Upstaging nodal status in colorectal cancer using ex vivo fluorescence sentinel lymph node mapping: preliminary results

Fluorescence Imaging in Colorectal Surgery: An Updated Review and Future Trends

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