Role of Indocyanine Green Fluorescence Imaging in Minimally Invasive Resection of Colorectal Liver Metastases

Abstract

Indocyanine green (ICG) fluorescence imaging is an easy and reproducible method to detect hepatic lesions, both primary and metastatic. This review reports the potential benefits of this technique as a tactile mimicking visual tool and a navigator guide in minimally invasive liver resection of colorectal liver metastases (CRLM). PubMed and MEDLINE databases were searched for studies reporting the use of intravenous injection of ICG before minimally invasive surgery for CLRM. The search was performed for publications reported from the first study in 2014 to April 2021. The final review included 13 articles: 6 prospective cohort studies, 1 retrospective cohort study, 3 case series, 1 case report, 1 case-matched study, and 1 clinical trial registry. The administered dose ranged between 0.3 and 0.5 mg/ kg, while timing ranged between 1 and 14 days before surgery. CRLM detection rate ranged between 30.3% and 100% with preoperative imaging (abdominal computed tomography/magnetic resonance imaging), between 93.3 and 100% with laparoscopic ultrasound, between 57.6% and 100% with ICG fluorescence, and was 100% with combined modalities (ICG and laparoscopic ultrasound) with weighted averages of 77.42%, 95.97%, 79.03%, and 100%, respectively. ICG fusion imaging also allowed to detect occult small-sized lesions, not diagnosed preoperatively. In addition, ICG is effective in real-time assessment of surgical margins by evaluating the integrity of the fluorescent rim around the CRLM.

Indocyanine Green Fluorescence Guided Surgery in Colorectal Surgery

“…However, the indications for the hepatic metastasectomy of colorectal origin are still evolving. Nevertheless, up to 1/3 of patients undergoing the curative resection of colorectal hepatic metastases will have R1 resections (<1 mm resection margin) or residual disease due to the inability to properly detect intraoperatively [ 102 ]. This can severely impact disease-free survival and overall survival.…”

“…There have been several reports on the use of ICG for intraoperatively localizing colorectal liver metastasis. The most recent review was by Picollo et al [ 102 ] in 2022 and included 13 studies (literature search through April 2021). The authors reported a wide variation in the timing of ICG administration (1 to 14 days preoperatively) as well an average detection rate of metastases with ICG of 79.03% (range: 57.6–100) compared to 95.97% (range: 93.3–100%) with intraoperative ultrasound.…”

Recent Progress in Second Near-Infrared (NIR-II) Fluorescence Imaging in Cancer

“…For example, ICG fusion imaging could detect occult small-sized lesions that had not been diagnosed preoperatively. In addition, ICG is effective in the real-time assessment of surgical margins by evaluating the integrity of the fluorescent rim around a colorectal liver metastases [ 87 ]. Allowing surgeons to tune intraoperatively to specific fluorescence detection bands in the NIR-I/II wavelength region should allow for visualization to be tailored to specific surgical tasks.…”

Laparoscopic Hepatectomy for Hepatocellular Carcinoma

“…Before the first laparoscopic hepatectomy reported in1990s, patients can only choose open hepatectomy as surgical treatment of liver tumor (6). As time goes on, the benefits of laparoscopic were discovered by surgeon such as less venous bleeding, more accessible to the liver inside the rib cage, and better magnified view (7).After the 2nd International Consensus Conference on Laparoscopic Liver Resection, laparoscopic liver resection has been spread explosively in North America, Europe and East Asia (8).At the same time many surgeons start to use Indocyanine Green Fluorescence Imaging as a tactile mimicking visual tool (9).…”