Real-time surgical margin assessment using ICG-fluorescence during laparoscopic and robot-assisted resections of colorectal liver metastases

Achterberg, Friso B.; Mulder, Babs G. Sibinga; Meijer, R.P.; Bonsing, Bert A.; Hartgrink, Henk H.; Mieog, J. Sven D.; Zlitni, Aimen; Park, Seung Min; Sarasqueta, Arantza Fariña; Vahrmeijer, Alexander L.; Swijnenburg, Rutger-Jan

doi:10.21037/atm-20-1999

Cited by 51 publications

(67 citation statements)

References 21 publications

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“…Image-guided surgeries, performed after injecting ICG dye into blood vessels, have been used to delineate the cancer margin in urology, hepatobiliary, and colorectal surgery, as well as to explore sentinel nodes; there are also reports of robots being used in monitoring the flap pedicle (38)(39)(40). Da Vinci's camera has a built-in Near Infrared (NIR) system which can be activated simply by finger trigger.…”

Section: Discussionmentioning

confidence: 99%

Robot-assisted surgeries in oral and maxillofacial area: a narrative review on the present, advantages and its future

Kim¹,

Cho²,

Kim³

2022

Front Oral Maxillofac Med

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To survey the advantages, future prospects, and cases using robotic systems in oromaxillofacial surgery.Background: With the accumulation of advances in minimally invasive surgery in the entire body area, robot-assisted surgeries have become very common in operating rooms, despite of their short history. Thus, advances in robotic surgery are accelerating rapidly, particularly with respect to the maxillofacial region. In this regard, researchers reviewed the literatures using the keywords given below, including systematic metaanalysis.Methods: The report follows the format of the "narrative review" and reviewed literatures extracted from the PubMed database since 1980 when 'Robotic surgical procedures', 'neck dissection' and 'oral surgery' were searched.Conclusions: Robotic surgery in the oral and maxillofacial region allows the incision to hide the scar by making the incision line far from the surgical field, resulting in fewer intra-operative and post-operative complications, such as amount of drainage or hospital days. Furthermore, recent studies show similar or superior results in terms of oncologic safety of robot assisted surgeries compared to conventional surgeries.Robotic surgery is likely to extend throughout the oral and maxillofacial region once it becomes capable of manipulating bone such as in osteotomies, particularly as robotic systems become smaller. When combined with artificial intelligence technology, the surgical robot will become more useful and powerful in relieving human suffering.

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Section: Discussionmentioning

confidence: 99%

Robot-assisted surgeries in oral and maxillofacial area: a narrative review on the present, advantages and its future

Kim¹,

Cho²,

Kim³

2022

Front Oral Maxillofac Med

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“…One-and 2-year DFS were 77.2% and 65%, respectively, and 1-year and 2-year overall survival rates were 91% and 84%, respectively [53]. Using of ICG fluorescence for real-time assessment of RM during laparoscopic and robot-assisted resection for CRLM was analyzed by Achterberg et al on 16 CRLM (R0 8 cases and R1 8 cases) with no protruding rim in the wound bed in vivo were diagnosed as having a tumor-negative margin in 88% of cases [54]. Aoki et al also used NIR fluorescence with ICG for determination of RM on 25 cases with liver malignancy (12 CRLM and 13 hepatocellular carcinoma).…”

Section: Discussionmentioning

confidence: 99%

Prospective Non-Randomized Study of Intraoperative Assessment of Surgical Resection Margin of Colo-Rectal Liver Metastases

Protić¹,

Krsmanovic²,

Šolajić³

et al. 2021

J. Cancer

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Introduction: More than 50% of patients with colorectal cancer (CRC) develop liver metastases during the natural course of disease. Surgical resection is currently the most potentially curative method in the treatment of colorectal liver metastases (CRLM). The goal of surgery is to achieve a negative resection margin (RM) of at least 1 mm, which provides the best prognosis for patients. The RM can be assessed by the pathologist of the resected liver specimen (RLS) and by the surgeon intraoperatively. The aim of this research paper is to determine the degree of agreement on intraoperative assessment of the RM by the surgeon and histopathological RM assessment by the pathologist. Material and methods: This prospective non-randomized double-blind study was approved by the Ethics Committee of the Oncology Institute of Vojvodina and registered on ClinicalTrials.gov #NCT04634526. The study was conducted at the Oncology Institute of Vojvodina, Sremska Kamenica, Serbia. An experienced hepatobiliary surgeon assessed RM for every specimen intra-operatively, immediately after CRLM resection. Resected CRLM lesions were analyzed by two experienced pathologists. These data were compared with pathological RM assessment as a "gold standard". RM of 1 mm or more was rated as negative RM (RM-). Disease-free survival (DFS) and recurrence rate was calculated by RM status defined by surgeon and by pathologist. Results: From 01 January 2015 to 31 August 2019, 98 patients were enrolled in the study. There were 219 RLS with 245 CRLM. The surgeon registered positive RM (RM+) of <1mm in 41 (18.7%) RLS. Taking the result of the histopathological assessment (HPA) as the "gold standard", it was determined that RM was true positive in 32 (14.6%) cases. False positive RM was found in 9 (4.1%) cases. False negative RM was found in 20 (9.1%) cases. True negative RM was found in 158 (72.2%) cases. Sensitivity of surgical assessment (SA) of RM+ was 61.5% (32/52). Specificity of SA of RM+ was 94.6% (158/167). The positive predictive value (PPV) was 78.0% (32/41), while the negative predictive value (NPV) was 88.8% (158/178). The overall accuracy of the RM+ SA was 86.8% (190/219). There was no statistically significant difference in the assessment of RM+ per RLS by surgeon and pathologists (p=0.061), but it was significant when analyses per patients was performed (p=0.017). Recurrence rate for RM+ patients was 48.1% (13/27, p=0.05) for SA and 35.0% (14/40, p=0.17) for HPA. Three year DFS for RM-and RM+ was 66.5% and 27.9% (p=0.04), respectively, by SA, and 64.8% and 42.1% (p=0.106), respectively, by HPA.

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“…Two small case series with a total of 52 patients achieved 100% tumour-negative resection margins using ICG to determine the precise tumour border [56,57]. Recently, a systematic workflow was proposed to detect or prevent tumour positive margins in CRLM surgery [60]. In a selected group of eight patients with initial tumour positive resection margins, the surgeons were able to correctly identify seven out of eight positive margins by using the proposed surgical workflow.…”

Section: Liver Metastasesmentioning

confidence: 99%

Fluorescence-guided surgery in colorectal cancer; A review on clinical results and future perspectives

Galema

Meijer

Lauwerends

et al. 2022

European Journal of Surgical Oncology

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Background: Colorectal cancer is the fourth most diagnosed malignancy worldwide and surgery is one of the cornerstones of the treatment strategy. Near-infrared (NIR) fluorescence imaging is a new and upcoming technique, which uses an NIR fluorescent agent combined with a specialised camera that can detect light in the NIR range. It aims for more precise surgery with improved oncological outcomes and a reduction in complications by improving discrimination between different structures. Methods: A systematic search was conducted in the Embase, Medline and Cochrane databases with search terms corresponding to 'fluorescence-guided surgery', 'colorectal surgery', and 'colorectal cancer' to identify all relevant trials. Results: The following clinical applications of fluorescence guided surgery for colorectal cancer were identified and discussed: (1) tumour imaging, (2) sentinel lymph node imaging, (3) imaging of distant metastases, (4) imaging of vital structures, (5) imaging of perfusion. Both experimental and FDA/EMA approved fluorescent agents are debated. Furthermore, promising future modalities are discussed. Conclusion: Fluorescence-guided surgery for colorectal cancer is a rapidly evolving field. The first studies show additional value of this technique regarding change in surgical management. Future trials should focus on patient related outcomes such as complication rates, disease free survival, and overall survival.

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Real-time surgical margin assessment using ICG-fluorescence during laparoscopic and robot-assisted resections of colorectal liver metastases

Cited by 51 publications

References 21 publications

Robot-assisted surgeries in oral and maxillofacial area: a narrative review on the present, advantages and its future

Robot-assisted surgeries in oral and maxillofacial area: a narrative review on the present, advantages and its future

Prospective Non-Randomized Study of Intraoperative Assessment of Surgical Resection Margin of Colo-Rectal Liver Metastases

Fluorescence-guided surgery in colorectal cancer; A review on clinical results and future perspectives

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