• Hepatectomy
• Liver
• Metastasis
• Non-colorectal
• Non-neuroendocrine

• Humans
• Prospective Studies
• Hepatectomy/adverse effects
• Liver Neoplasms/surgery
• Liver Neoplasms/pathology
• Disease-Free Survival
• Colorectal Neoplasms/pathology

Near-infrared (NIR) imaging with indocyanine green (ICG) is a sensitive intraoperative tool for detecting liver tumors. NIR imaging has been used to distinguish metastatic liver cancer from colon cancer; however, its utility for identifying metastatic lesions from gastric cancer remains unknown. We present a case of advanced gastric cancer with multiple liver metastases, which was diagnosed and treated using intraoperative NIR imaging with ICG.

A 69-year-old man with advanced gastric cancer and simultaneous multiple liver metastases presented with gastric bleeding. He underwent gastrectomy and chemotherapy, which reduced the tumor burden. No new lesions were noted, and the patient was advised to undergo surgical resection of the residual liver metastases. Prior to surgery, 0.5 mg/kg of intravenous ICG was administered. NIR imaging was performed during hepatectomy, which revealed clear green fluorescence in several liver segments, indicating liver metastases. Two lesions were not identified during preoperative magnetic resonance imaging. All fluorescent areas were resected. The tumors identified by both preoperative and fluoresced intraoperatively demonstrated malignant features on histopathological examination. The two lesions that fluoresced intraoperatively but were not identified on preoperative images demonstrated normal liver parenchyma and no signs of malignancy. The patient remains tumor-free 1 year after surgery.

This report demonstrates that hepatic metastases from gastric cancer can be diagnosed with intraoperative NIR imaging with ICG.

NIR imaging with ICG can detect liver metastases but may provide false positive results. As the percentage of false positives is high, additional resections must be decided upon carefully.

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We used intraoperative NIR-ICG imaging to detect gastric cancer liver metastases.

Pancreatic cancer with synchronous liver metastasis has an extremely poor prognosis, and surgery is not recommended for such patients by the current guidelines. However, an increasing body of studies have shown that concurrent resection of pancreatic cancer and liver metastasis is not only technically feasible but also beneficial to the survival in the selected patients. In this review, we aim to summarize the short- and long-term outcomes following synchronous liver metastasectomy for pancreatic cancer patients, and discuss the potential criteria in selecting appropriate surgical candidates, which might be helpful in clinical decision-making.

• liver metastasis
• pancreatic cancer
• postoperative outcome
• selecting criteria
• surgical resection

To analyse the safety and efficacy of curative intent surgery in biliary and pancreatic cancer.

An extensive literature review was performed using MEDLINE, Google Scholar and EMBASE to identify articles regarding hepato-pancreatoduodenectomy or resection of liver metastasis in patients with pancreatic, biliary tract, periampullary and gallbladder cancers.

A total of 19 studies were identified and reviewed. Major hepatectomy was undertaken in 391 patients. The median overall survival for pancreatic cancer ranged from 5-36 mo and for biliary tract/gallbladder cancer, it was 8-38 mo. The 30 d mortality rate was only 1%-9%. Overall Survival was significantly better for patients, who had good response to neoadjuvant chemotherapy, underwent metachronous liver resection and who had intestinal type tumours.

Resection of liver metastases in pancreatic and biliary cancers may provide survival benefit without compromising safety and quality of life in a very select group of patients. These data may be utilised to formulate selection criteria that may allow future investigation of resection in the era of more effective systemic therapy.

• Pancreas
• Liver resection
• Gall bladder
• Cholangiocarcinoma
• Review

• Gastric cancer
• Hepatectomy
• Liver metastases
• Long-term survival
• Prognostic factors