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Gao F, Xie Q, Zhao X, Yang M, Jiang K, Mao T, Yang J, Wu H. Laparoscopic hepatectomy and near-infrared fluorescence based on the concept of "biliary territory" in the treatment of hepatolithiasis: a propensity score-matched study with videos. Hepatobiliary Surg Nutr 2025; 14:194-206. [PMID: 40342766 PMCID: PMC12057517 DOI: 10.21037/hbsn-23-643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 04/02/2024] [Indexed: 05/11/2025]
Abstract
Background Hepatolithiasis, a common condition in East Asia, often requires surgical treatment. The aim of this study was to evaluate the safety and efficacy of near-infrared fluorescence (NIF)-guided laparoscopic hepatectomy (LH) using the 'biliary territory' concept for hepatolithiasis. Methods This retrospective study included 97 patients who had undergone LH for hepatolithiasis between June 2018 and November 2022. The patients were divided into two groups based on whether intraoperative NIF-guided (n=31) or traditional white light (WL) laparoscopy (n=66) had been performed. Propensity score matching (PSM) was used to create 27 pairs for comparison. Perioperative outcomes, stone recurrence, and recurrence-free survival (RFS) were assessed. Results Prior to PSM, NIF guidance was associated with reduced bleeding (P=0.01) and a lower conversion rate (P=0.001). After PSM, only the postoperative albumin concentration differed significantly between the two groups (P=0.003). The median duration of follow-up was 36 months. Before PSM, RFS differed significantly between the groups (P=0.009), whereas in the matched cohort, the stone recurrence rate was 33.3% in the WL group and 7.4% in the NIF group; however, the RFS did not differ significantly between these groups (P=0.09). Postoperative complications were identified by Cox regression analysis as an independent risk factor for recurrence (95% CI: 1.02-15.21, P=0.047). Conclusions NIF-guided LH is a safe and effective approach to the treatment of hepatolithiasis, long-term outcomes being comparable to those of traditional techniques. Future studies should be larger and have longer follow-up.
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Affiliation(s)
- Fengwei Gao
- Liver Transplantation Center, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, China
| | - Qingyun Xie
- Liver Transplantation Center, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, China
| | - Xin Zhao
- Department of Hepato-Pancreato-biliary Surgery, People’s Hospital of Leshan, Leshan, China
| | - Manyu Yang
- North Sichuan Medical College, Nanchong, China
| | - Kangyi Jiang
- Department of Hepato-Pancreato-biliary Surgery, People’s Hospital of Leshan, Leshan, China
| | | | - Jiayin Yang
- Liver Transplantation Center, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, China
| | - Hong Wu
- Liver Transplantation Center, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, China
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Avella P, Spiezia S, Rotondo M, Cappuccio M, Scacchi A, Inglese G, Guerra G, Brunese MC, Bianco P, Tedesco GA, Ceccarelli G, Rocca A. Real-Time Navigation in Liver Surgery Through Indocyanine Green Fluorescence: An Updated Analysis of Worldwide Protocols and Applications. Cancers (Basel) 2025; 17:872. [PMID: 40075718 PMCID: PMC11898688 DOI: 10.3390/cancers17050872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2025] [Revised: 02/13/2025] [Accepted: 02/24/2025] [Indexed: 03/14/2025] Open
Abstract
BACKGROUND Indocyanine green (ICG) fluorescence has seen extensive application across medical and surgical fields, praised for its real-time navigation capabilities and low toxicity. Initially employed to assess liver function, ICG fluorescence is now integral to liver surgery, aiding in tumor detection, liver segmentation, and the visualization of bile leaks. This study reviews current protocols and ICG fluorescence applications in liver surgery, with a focus on optimizing timing and dosage based on clinical indications. METHODS Following PRISMA guidelines, we systematically reviewed the literature up to 27 January 2024, using PubMed and Medline to identify studies on ICG fluorescence used in liver surgery. A systematic review was performed to evaluate dosage and timing protocols for ICG administration. RESULTS Of 1093 initial articles, 140 studies, covering a total of 3739 patients, were included. The studies primarily addressed tumor detection (40%), liver segmentation (34.6%), and both (21.4%). The most common ICG fluorescence dose for tumor detection was 0.5 mg/kg, with administration occurring from days to weeks pre-surgery. Various near-infrared (NIR) camera systems were utilized, with the PINPOINT system most frequently cited. Tumor detection rates averaged 87.4%, with a 10.5% false-positive rate. Additional applications include the detection of bile leaks, lymph nodes, and vascular and biliary structures. CONCLUSIONS ICG fluorescence imaging has emerged as a valuable tool in liver surgery, enhancing real-time navigation and improving clinical outcomes. Standardizing protocols could further enhance ICG fluorescence efficacy and reliability, benefitting patient care in hepatic surgeries.
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Affiliation(s)
- Pasquale Avella
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80138 Naples, Italy
- Hepatobiliary and Pancreatic Surgery Unit, Department of General Surgery, Pineta Grande Hospital, 81030 Castel Volturno, Italy
- Department of Medicine and Health Science “V. Tiberio”, University of Molise, 86100 Campobasso, Italy
| | - Salvatore Spiezia
- Department of Medicine and Health Science “V. Tiberio”, University of Molise, 86100 Campobasso, Italy
| | - Marco Rotondo
- Department of Medicine and Health Science “V. Tiberio”, University of Molise, 86100 Campobasso, Italy
| | - Micaela Cappuccio
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80138 Naples, Italy
| | - Andrea Scacchi
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Monza, Italy
| | - Giustiniano Inglese
- Department of Medicine and Health Science “V. Tiberio”, University of Molise, 86100 Campobasso, Italy
| | - Germano Guerra
- Department of Medicine and Health Science “V. Tiberio”, University of Molise, 86100 Campobasso, Italy
| | - Maria Chiara Brunese
- Department of Medicine and Health Science “V. Tiberio”, University of Molise, 86100 Campobasso, Italy
| | - Paolo Bianco
- Hepatobiliary and Pancreatic Surgery Unit, Department of General Surgery, Pineta Grande Hospital, 81030 Castel Volturno, Italy
| | - Giuseppe Amedeo Tedesco
- Department of Medicine and Health Science “V. Tiberio”, University of Molise, 86100 Campobasso, Italy
| | - Graziano Ceccarelli
- Division of General and Minimally Invasive Surgery, Department of Surgery, San Giovanni Battista Hospital, 06034 Foligno, Italy
- Minimally Invasive and Robotic Surgery Unit, San Matteo Hospital, 06049 Spoleto, Italy
| | - Aldo Rocca
- Hepatobiliary and Pancreatic Surgery Unit, Department of General Surgery, Pineta Grande Hospital, 81030 Castel Volturno, Italy
- Department of Medicine and Health Science “V. Tiberio”, University of Molise, 86100 Campobasso, Italy
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Wang G, Liu C, Qi W, Li L, Xiu D. Role of indocyanine green fluorescence imaging in margin assessment and recurrence-free survival in laparoscopic parenchyma-sparing hepatectomy for neuroendocrine tumor liver metastases. Surg Endosc 2025; 39:1574-1582. [PMID: 39762608 DOI: 10.1007/s00464-024-11508-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2024] [Accepted: 12/27/2024] [Indexed: 03/03/2025]
Abstract
BACKGROUND Neuroendocrine liver metastases (NELM) significantly reduce survival in patients with neuroendocrine tumor. The management of NELM is challenged by a low rate of resectability and a high rate of recurrence. Indocyanine green (ICG) fluorescence imaging offers potential advantages in real-time tumor visualization and margin assessment. This study evaluates the impact of ICG fluorescence on perioperative outcomes and recurrence-free survival (RFS) in NELM patients undergoing laparoscopic parenchyma-sparing hepatectomy (LPSH). METHODS A retrospective cohort study was performed on patients with NELM who underwent LPSH from August 2013 to May 2023 at our single center. Data on sociodemographic characteristics, laboratory parameters, surgical results and follow-up outcomes were collected. RESULTS A total of 51 NELM patients were included. No significant differences in baseline characteristics were observed between the ICG and non-ICG groups. Postoperative complications occurred in 52.9% of patients, with bile leakage being most common. No perioperative mortality was reported. Pathologically positive margins were significantly lower in the ICG group (1.3 vs. 16.4%, p < 0.001). After a median follow-up of 36 months, 62.7% of patients experienced recurrence, mostly intrahepatic. Median recurrence-free survival (RFS) was longer in the ICG group, though not statistically significant (38.0 vs. 29.0 months, p = 0.086). CONCLUSION The use of ICG fluorescence imaging in LPSH may improve surgical margins and potentially enhance RFS in NELM patients. These findings are clinically significant, highlighting the need for larger prospective studies to confirm its impact on long-term prognosis.
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Affiliation(s)
- Gaoming Wang
- Department of General Surgery, Peking University Third Hospital, Beijing, 100191, China
| | - Chenghao Liu
- Department of General Surgery, Peking University Third Hospital, Beijing, 100191, China
| | - Weijun Qi
- Department of General Surgery, Peking University Third Hospital, Beijing, 100191, China
| | - Long Li
- Department of General Surgery, Peking University Third Hospital, Beijing, 100191, China
| | - Dianrong Xiu
- Department of General Surgery, Peking University Third Hospital, Beijing, 100191, China.
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Zeng X, Li X, Lin W, Wang J, Fang C, Pan M, Tao H, Yang J. Efficacy of laparoscopic parenchyma-sparing hepatectomy using augmented reality navigation combined with fluorescence imaging for colorectal liver metastases: a retrospective cohort study using inverse probability treatment weighting analysis. Int J Surg 2025; 111:1749-1759. [PMID: 39715148 DOI: 10.1097/js9.0000000000002193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Accepted: 11/15/2024] [Indexed: 12/25/2024]
Abstract
BACKGROUND Laparoscopic parenchyma-sparing hepatectomy (PSH) is an effective treatment for colorectal liver metastases (CRLMs), but ensuring the safety and radicality of the procedure, particularly for deep-seated tumors, remains challenging. Surgical navigation technologies such as augmented reality navigation (ARN) and indocyanine green fluorescence imaging (ICG-FI) are increasingly utilized to guide surgery, yet their efficacy for CRLMs is unclear. This study aims to evaluate the short-term and long-term outcomes of ARN combined with ICG-FI-guided (ARN-FI) laparoscopic PSH for CRLMs. METHODS Between January 2020 and December 2022, 89 consecutive patients who underwent laparoscopic PSH for CRLMs were included in the study. Patients were divided into an ARN-FI group ( n = 38) and a non-ARN-FI group ( n = 51) based on the use of ARN-FI. Inverse probability treatment weighting (IPTW) was used to balance baseline characteristics and minimize potential selection bias. Short-term and long-term outcomes were compared between the two groups. Cox regression analysis was conducted to identify risk factors associated with recurrence-free survival (RFS) and hepatic RFS. RESULTS After IPTW, there were 87 patients in the ARN-FI group and 89 patients in the non-ARN-FI group. Shorter parenchymal transection time, postoperative hospital stays, and wider margins were observed in the ARN-FI group. There was no significant difference in RFS or hepatic RFS between the groups. Mutant KRAS status was an independent risk factor for both RFS and hepatic RFS, while tumor diameter ≥ 5 cm and deep-seated location were risk factors for hepatic RFS. In the subgroup analysis of deep-seated tumors, the ARN-FI group also showed less intraoperative blood loss, a lower rate of strategy change, shorter postoperative recovery times, a higher R0 resection rate, and improved RFS and hepatic RFS. CONCLUSIONS In laparoscopic PSH for CRLMs, ARN-FI may improve surgical efficiency and accuracy. Especially for deep-seated tumors, it has the potential to reduce blood loss and attain higher R0 resection rates.
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Affiliation(s)
- Xiaojun Zeng
- Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Guangdong Provincial Clinical and Engineering Center of Digital Medicine, Guangzhou, China
| | - Xinci Li
- Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Guangdong Provincial Clinical and Engineering Center of Digital Medicine, Guangzhou, China
| | - Wenjun Lin
- Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Guangdong Provincial Clinical and Engineering Center of Digital Medicine, Guangzhou, China
| | - Junfeng Wang
- Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Guangdong Provincial Clinical and Engineering Center of Digital Medicine, Guangzhou, China
| | - Chihua Fang
- Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Guangdong Provincial Clinical and Engineering Center of Digital Medicine, Guangzhou, China
| | - Mingxin Pan
- Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Guangdong Provincial Clinical and Engineering Center of Digital Medicine, Guangzhou, China
| | - Haisu Tao
- Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Guangdong Provincial Clinical and Engineering Center of Digital Medicine, Guangzhou, China
| | - Jian Yang
- Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Guangdong Provincial Clinical and Engineering Center of Digital Medicine, Guangzhou, China
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Wang G, Liu C, Qi W, Li L, Xiu D. Perioperative and recurrence-free survival outcomes after laparoscopic hepatectomy for colorectal cancer liver metastases using indocyanine green fluorescence imaging: an inverse probability treatment weighted analysis. Surg Endosc 2025; 39:1169-1181. [PMID: 39715956 DOI: 10.1007/s00464-024-11478-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2024] [Accepted: 12/04/2024] [Indexed: 12/25/2024]
Abstract
BACKGROUND Colorectal cancer (CRC) frequently metastasizes to the liver, significantly worsening patient outcomes. While hepatectomy offers the best curative option for colorectal liver metastases (CRLM), margin recurrence remains a major challenge post-surgery. Intraoperative ultrasound (IOUS) aids tumor identification and margin determination, but its limitations in laparoscopic surgery necessitate additional methods. Indocyanine green fluorescence imaging (ICGFI) has emerged as a promising tool for tumor localization and margin assessment in CRLM. However, existing studies lack large cohorts and long-term outcomes. This study evaluates perioperative and long-term results of ICGFI-assisted laparoscopic hepatectomy in CRLM patients. METHOD A retrospective cohort study was performed on CRLM patients who underwent liver resection at our single center. The study population was divided into three groups: the L-ICG group (laparoscopic hepatectomy with ICGFI), the L-Non-ICG group (laparoscopic hepatectomy without ICGFI), and the open group (open liver resection). Robust statistical methods including multiple imputations and inverse probability of treatment weighting (IPTW) were employed to minimize bias. RESULTS A total of 340 CRLM patients who underwent hepatectomy were analyzed. The L-ICG group had a higher rate of neoadjuvant therapy and smaller tumor sizes compared to the open group. The L-ICG group also demonstrated shorter operative times, less blood loss, and a higher microscopically margin-negative (R0) resection rate than other two groups. Recurrence occurred in 70% of patients, with 77% being intrahepatic. Margin recurrence was significantly lower in the L-ICG group compared to the L-Non-ICG group (15.3% vs. 45.7%, p = 0.001). Median recurrence-free survival and overall survival did not differ significantly among groups after IPTW adjustment. CONCLUSION ICGFI improves R0 resection rates, perioperative outcomes, and reduces margin recurrence in CRLM patients undergoing laparoscopic hepatectomy, though it does not significantly impact OS or RFS.
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Affiliation(s)
- Gaoming Wang
- Department of General Surgery, Peking University Third Hospital, Beijing, 100191, China
| | - Chenghao Liu
- Department of General Surgery, Peking University Third Hospital, Beijing, 100191, China
| | - Weijun Qi
- Department of General Surgery, Peking University Third Hospital, Beijing, 100191, China
| | - Long Li
- Department of General Surgery, Peking University Third Hospital, Beijing, 100191, China
| | - Dianrong Xiu
- Department of General Surgery, Peking University Third Hospital, Beijing, 100191, China.
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Paramythiotis D, Karlafti E, Tsavdaris D, Apostolidou Kiouti F, Haidich AB, Ioannidis A, Panidis S, Michalopoulos A. The Effect of Hepatic Surgical Margins of Colorectal Liver Metastases on Prognosis: A Systematic Review and Meta-Analysis. J Clin Med 2024; 13:7776. [PMID: 39768699 PMCID: PMC11727772 DOI: 10.3390/jcm13247776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2024] [Revised: 12/14/2024] [Accepted: 12/16/2024] [Indexed: 01/16/2025] Open
Abstract
Introduction: Colorectal cancer is the third most common malignancy, with around half of patients developing liver metastases. Hepatectomy is the preferred treatment, but its success depends on several factors, including surgical margins. Various surgical margins have been suggested to achieve optimal results. This systematic review and meta-analysis aim to explore the impact of negative surgical margins ranging from 1 to 10 mm, and >10 mm on survival, with the objective of identifying optimal surgical margins. Methods: A systematic literature search was conducted on the MEDLINE, Scopus, and Cochrane databases. The six included studies that examined the effect of surgical margins at the aforementioned distances on patient survival. Studies were assessed for risk of bias using the Quality in Prognosis Studies tool. Statistical analysis was performed using SPSS software. Results: The results of the meta-analysis revealed the superiority of wider surgical margins (>10) on overall survival compared to smaller margins (1-10 mm), as the HR was calculated to be 1.38 [1.10; 1.73]. Specifically, negative margins between 1 and 10 mm are linked to a 38% increased risk of mortality compared to margins larger than 10 mm. The low heterogeneity indicates consistent findings across studies, and the statistically significant hazard ratio underscores the importance of aiming for larger surgical margins to enhance patient outcomes. In the subgroup that included only studies in which patients received neoadjuvant therapy, the HR was 1.48 [1.06; 2.07], further emphasizing the importance of ensuring negative surgical margins in today's era. Conclusions: In summary, this systematic review and meta-analysis highlights the impact of surgical margin width on the survival of patients with colorectal liver metastases, as well as the importance of margin optimization in surgical management strategies.
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Affiliation(s)
- Daniel Paramythiotis
- First Propaedeutic Surgery Department, University General Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (D.P.); (D.T.); (A.I.); (S.P.); (A.M.)
| | - Eleni Karlafti
- Emergency Department, University General Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
- First Propaedeutic Department of Internal Medicine, University General Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Dimitrios Tsavdaris
- First Propaedeutic Surgery Department, University General Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (D.P.); (D.T.); (A.I.); (S.P.); (A.M.)
| | - Fani Apostolidou Kiouti
- Department of Hygiene, Social-Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, University Campus, 54124 Thessaloniki, Greece (A.-B.H.)
| | - Anna-Bettina Haidich
- Department of Hygiene, Social-Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, University Campus, 54124 Thessaloniki, Greece (A.-B.H.)
| | - Aristeidis Ioannidis
- First Propaedeutic Surgery Department, University General Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (D.P.); (D.T.); (A.I.); (S.P.); (A.M.)
| | - Stavros Panidis
- First Propaedeutic Surgery Department, University General Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (D.P.); (D.T.); (A.I.); (S.P.); (A.M.)
| | - Antonios Michalopoulos
- First Propaedeutic Surgery Department, University General Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (D.P.); (D.T.); (A.I.); (S.P.); (A.M.)
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Li K, Yang J, Lian H, Tian Z, Li C, Gao N, Guo Z. Cutting-edge insights: near-infrared imaging for surgical margin assessment in head and neck tumor resection: a systematic review and meta-analysis. Quant Imaging Med Surg 2024; 14:8167-8182. [PMID: 39698655 PMCID: PMC11651944 DOI: 10.21037/qims-24-564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 09/23/2024] [Indexed: 12/20/2024]
Abstract
BACKGROUND In head and neck cancer (HNC), real-time evaluation of tumor margin status following surgical excision of the tumor is of critical importance. This systematic review aimed to assess the effectiveness of near-infrared fluorescence (NIRF) imaging for the real-time delineation of tumor margins in HNC resections. METHODS Two investigators independently conducted a comprehensive search following the Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy Studies (PRISMA-DTA) guidelines across the PubMed, Scopus, Embase, and China National Knowledge Infrastructure (CNKI) databases until August 1st, 2023. Observational studies were included, while other studies with inappropriate study design were excluded. The primary outcomes included the specificity, sensitivity, and area under the summary receiver operating characteristic (SROC) curve when using NIRF imaging to assess surgical margins. We compared fluorescence in the resection specimen margins and residual fluorescence in the surgical cavity margins as methods of utilizing NIRF to evaluate surgical margins. Diagnostic trial quality was assessed, and statistical heterogeneity was determined. RESULTS The initial search yielded 1,607 articles. After reviewing the full texts, seven articles with 103 patients were included, among which five were incorporated for quantitative analysis. The selected studies had an average score of 10.1 of quality. Heterogeneity analysis revealed I2 values of 26% [95% confidence interval (CI): 0-100%] and 78% (95% CI: 52-100%) for NIRF specimen imaging with close margin considered positive or negative. Comparing NIRF imaging to the gold standard of pathology for surgical margin diagnosis, with close margin considered positive, sensitivity and specificity in excised specimens were 0.84 (95% CI: 0.39-0.98) and 0.96 (95% CI: 0.80-0.99), respectively. When a close margin was considered negative, sensitivity and specificity were 0.98 (95% CI: 0.10-1.00) and 0.96 (95% CI: 0.45-1.00), respectively. The areas under the SROC curves were 0.97 (95% CI: 0.95-0.98) and 0.99 (95% CI: 0.98-1.00), respectively. A quantitative analysis of residual fluorescence at surgical cavity margins was not performed due to an insufficient number of studies. CONCLUSIONS NIRF imaging is a promising method for real-time surgical margin assessment of HNC. With its robust diagnostic capabilities in excised tumor specimens, it is also an effective technique for detecting residual tumor fluorescence in the surgical cavity for supplementary assessment. But the results should be interpreted with caution.
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Affiliation(s)
- Ke Li
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Jiajin Yang
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Haosen Lian
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Zixi Tian
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Chunjie Li
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Ning Gao
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Zhiyong Guo
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
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Fadel MG, Zonoobi E, Rodríguez-Luna MR, Mishima K, Ris F, Diana M, Vahrmeijer AL, Perretta S, Ashrafian H, Fehervari M. Efficacy and Safety of Fluorescence-Guided Surgery Compared to Conventional Surgery in the Management of Colorectal Cancer: A Systematic Review and Meta-Analysis. Cancers (Basel) 2024; 16:3377. [PMID: 39409997 PMCID: PMC11476237 DOI: 10.3390/cancers16193377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2024] [Revised: 09/09/2024] [Accepted: 09/24/2024] [Indexed: 10/20/2024] Open
Abstract
BACKGROUND The use of fluorescence agents and imaging systems is a promising adjunct in the surgical management of colorectal cancer. This systematic review and meta-analysis aimed to assess the safety and efficacy of fluorescence-guided surgery in the management of colorectal cancer, with a comparison to conventional (non-fluorescence-guided) surgery. METHODS A literature search of MEDLINE, Embase, Emcare, and CINAHL databases was performed for studies that reported data on the outcomes of fluorescence-guided surgery, with or without a comparison group undergoing conventional surgery, for colorectal cancer between January 2000 and January 2024. A meta-analysis was performed using random-effect models, and between-study heterogeneity was assessed. RESULTS 35 studies of 3217 patients with colorectal cancer were included: 26 studies (964 patients) reported on fluorescence-guided surgery and 9 studies (2253 patients) reported on fluorescence versus conventional surgery. The weighted mean of the cancer detection rate of fluorescence-guided surgery was 71% (95% CI 0.55-0.85), with no significant difference in lymph node yield ratio (WMD -0.04; 95% CI -0.10-0.02; p = 0.201) between fluorescence and conventional surgery groups. There was a significantly lower blood loss (WMD -4.38; 95% CI -7.05--1.70; p = 0.001) and complication rate (WMD -0.04; 95% CI -0.07-0.00; p = 0.027) in the fluorescence-guided surgery group, with a potentially lower anastomotic leak rate (WMD -0.05; 95% CI -0.10-0.01; p = 0.092). CONCLUSIONS Fluorescence-guided surgery is a safe and effective approach in the management of colorectal cancer, potentially reducing blood loss and complications. Further randomised controlled trials are required comparing fluorescence-guided surgery with conventional surgery to determine its prognostic benefit and where it should precisely fit within the management pathway of colorectal cancer.
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Affiliation(s)
- Michael G. Fadel
- Department of Surgery and Cancer, Imperial College London, London SW7 2AZ, UK
- Department of General Surgery, Chelsea and Westminster Hospital, London SW10 9NH, UK
| | - Elham Zonoobi
- Edinburgh Molecular Imaging Limited, Nine Edinburgh Bioquarter, Edinburgh EH16 4UX, UK
- Department of Surgery, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | | | - Kohei Mishima
- Research Institute Against Digestive Cancer (IRCAD), 67000 Strasbourg, France
| | - Frédéric Ris
- Department of Surgery, University Hospital of Geneva, 1205 Geneva, Switzerland
- Faculty of Medicine, University of Geneva, 1211 Geneva, Switzerland
| | - Michele Diana
- Department of Surgery, University Hospital of Geneva, 1205 Geneva, Switzerland
- Faculty of Medicine, University of Geneva, 1211 Geneva, Switzerland
- ICube Laboratory, Photonics Instrumentation for Health, 67034 Strasbourg, France
| | | | - Silvana Perretta
- Research Institute Against Digestive Cancer (IRCAD), 67000 Strasbourg, France
- IHU-Strasbourg, Institute of Image-Guided Surgery, 67000 Strasbourg, France
- Department of Digestive and Endocrine Surgery, University of Strasbourg, 67081 Strasbourg, France
| | - Hutan Ashrafian
- Department of Surgery and Cancer, Imperial College London, London SW7 2AZ, UK
| | - Matyas Fehervari
- Department of Surgery and Cancer, Imperial College London, London SW7 2AZ, UK
- Department of Gastrointestinal Surgery, Maidstone and Tunbridge Wells NHS Trust, Tunbridge Wells TN2 4QJ, UK
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9
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Fortuna L, Buccianti S, Risaliti M, Matarazzo F, Agostini C, Ringressi MN, Taddei A, Bartolini I, Grazi GL. Indocyanine Green and Hepatobiliary Surgery: An Overview of the Current Literature. J Laparoendosc Adv Surg Tech A 2024; 34:921-931. [PMID: 39167475 DOI: 10.1089/lap.2024.0166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2024] Open
Abstract
Indocyanine green (ICG) is an inert polypeptide that almost totally binds to high molecular weight plasma proteins; it is cleared by the hepatocytes and directly excreted into the bile with a half-life of about 3-5 minutes. Specific systems are required to see fluorescent images. The use of this dye has been reported in different surgical specialties, and the applications in hepatobiliary surgery are widening. Being firstly used to evaluate the preoperative liver function, intra- and postoperative dynamic checking of hepatic activity has been reported and integrated within perioperative protocols allowing a tailored treatment allocation. Intravenous injection (IV) or injection into the gallbladder can ease difficult cholecystectomy. Biliary leakage detection could be enhanced by IV ICG injection. Although with some contrasting results, the use of ICG for both delineating the limits of the resection and tumor-enhanced visualization was demonstrated to improve short- and long-term outcomes. Although the lack of strong evidence still precludes the introduction of this tool in clinical practice, it harbors great potential in liver surgery.
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Affiliation(s)
- Laura Fortuna
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Simone Buccianti
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Matteo Risaliti
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Francesco Matarazzo
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Carlotta Agostini
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | | | - Antonio Taddei
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Ilenia Bartolini
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Gian Luca Grazi
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
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10
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Kang LM, Zhang FW, Yu FK, Xu L. Pay attention to the application of indocyanine green fluorescence imaging technology in laparoscopic liver cancer resection. World J Clin Cases 2024; 12:5288-5293. [PMID: 39156091 PMCID: PMC11238683 DOI: 10.12998/wjcc.v12.i23.5288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 05/27/2024] [Accepted: 06/07/2024] [Indexed: 07/05/2024] Open
Abstract
Traditional laparoscopic liver cancer resection faces challenges, such as difficulties in tumor localization and accurate marking of liver segments, as well as the inability to provide real-time intraoperative navigation. This approach falls short of meeting the demands for precise and anatomical liver resection. The introduction of fluorescence imaging technology, particularly indocyanine green, has demonstrated significant advantages in visualizing bile ducts, tumor localization, segment staining, microscopic lesion display, margin examination, and lymph node visualization. This technology addresses the inherent limitations of traditional laparoscopy, which lacks direct tactile feedback, and is increasingly becoming the standard in laparoscopic procedures. Guided by fluorescence imaging technology, laparoscopic liver cancer resection is poised to become the predominant technique for liver tumor removal, enhancing the accuracy, safety and efficiency of the procedure.
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Affiliation(s)
- Li-Min Kang
- Department of Hepatobiliary and Pancreatic Surgery, Puer People's Hospital, Puer 665000, Yunnan Province, China
| | - Fu-Wei Zhang
- Department of Hepatobiliary and Pancreatic Surgery, Puer People's Hospital, Puer 665000, Yunnan Province, China
| | - Fa-Kun Yu
- Department of Hepatobiliary and Pancreatic Surgery, Puer People's Hospital, Puer 665000, Yunnan Province, China
| | - Lei Xu
- Department of Hepatobiliary and Pancreatic Surgery, Puer People's Hospital, Puer 665000, Yunnan Province, China
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11
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McIntyre SM, Soares KC, Chou JF, D'Amico F, Shin PJ, Gönen M, Shia J, Balachandran VP, Wei AC, Kingham TP, Drebin JA, Jarnagin WR, D'Angelica MI. Surgical Margin of Resected Colorectal Liver Metastases: How Accurate Is Surgeon Prediction? Ann Surg 2024; 280:311-316. [PMID: 38054376 PMCID: PMC11153333 DOI: 10.1097/sla.0000000000006138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
OBJECTIVE The aim of this study was to describe the surgeon's ability to accurately predict the margin following resection of colorectal liver metastases (CRLMs). BACKGROUND The decision to resect CRLM is based on the surgeon's ability to predict tumor-free resection margins. However, to date, no study has evaluated the accuracy of surgeon margin prediction. METHODS In this single-institution prospective study, the operating attending and fellow independently completed a preoperative and postoperative questionnaire describing their expected resection margin in 100 consecutive cases (200 assessments) of CRLM resections. In cases with multiple metastases, the closest margin was assessed as the margin of interest for the primary outcome. Surgeon assessments were compared with the gold-standard histopathologic assessment. RESULTS After excluding aborted cases, 190 preoperative and 190 postoperative assessments from 95 cases were included in the analysis. The pathologic margin was noted to be wide (≥1 cm), 1 mm to 1 cm, narrow (<1 mm), and positive in 28 (29.5%), 55 (57.9%), 5 (5.3%), and 7 (7.4%) cases, respectively. The 88 cases with negative margins were all predicted to be negative. None of the cases with positive margins were predicted to be positive. Ninety-one (48%) preoperative and 104 (55%) postoperative predictions were accurate. The sensitivity of predicting a margin <1 mm was 8.3% preoperatively and 16.7% postoperatively. The positive predictive value for preoperative and postoperative predictions of margin <1 mm was 18.2% and 26.7%, respectively. CONCLUSIONS Surgeons are inaccurate at predicting positive and close surgical margins following resection of CRLM. A predicted close margin should not necessarily preclude resection.
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Affiliation(s)
- Sarah M McIntyre
- Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Kevin C Soares
- Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Joanne F Chou
- Department of Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Francesco D'Amico
- Department of Surgical, Oncological, and Gastroenterological Sciences (DiSCOG), University of Padova, Padua, Italy
| | - Paul J Shin
- Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Mithat Gönen
- Department of Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Jinru Shia
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Vinod P Balachandran
- Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Alice C Wei
- Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - T Peter Kingham
- Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Jeffrey A Drebin
- Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - William R Jarnagin
- Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Michael I D'Angelica
- Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY
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12
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Igami T, Hayashi Y, Yokyama Y, Mori K, Ebata T. Development of real-time navigation system for laparoscopic hepatectomy using magnetic micro sensor. MINIM INVASIV THER 2024; 33:129-139. [PMID: 38265868 DOI: 10.1080/13645706.2023.2301594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 12/04/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND We report a new real-time navigation system for laparoscopic hepatectomy (LH), which resembles a car navigation system. MATERIAL AND METHODS Virtual three-dimensional liver and body images were reconstructed using the "New-VES" system, which worked as roadmap during surgery. Several points of the patient's body were registered in virtual images using a magnetic position sensor (MPS). A magnetic transmitter, corresponding to an artificial satellite, was placed about 40 cm above the patient's body. Another MPS, corresponding to a GPS antenna, was fixed on the handling part of the laparoscope. Fiducial registration error (FRE, an error between real and virtual lengths) was utilized to evaluate the accuracy of this system. RESULTS Twenty-one patients underwent LH with this system. Mean FRE of the initial five patients was 17.7 mm. Mean FRE of eight patients in whom MDCT was taken using radiological markers for registration of body parts as first improvement, was reduced to 10.2 mm (p = .014). As second improvement, a new MPS as an intraoperative body position sensor was fixed on the right-sided chest wall for automatic correction of postural gap. The preoperative and postoperative mean FREs of 8 patients with both improvements were 11.1 mm and 10.1 mm (p = .250). CONCLUSIONS Our system may provide a promising option that virtually guides LH.
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Affiliation(s)
- Tsuyoshi Igami
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yuichiro Hayashi
- Graduate School of Informatics, Nagoya University, Nagoya, Japan
| | - Yukihiro Yokyama
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kensaku Mori
- Graduate School of Informatics, Nagoya University, Nagoya, Japan
- Information Strategy Office, Information and Communications, Nagoya University, Nagoya, Japan
| | - Tomoki Ebata
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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13
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Piccolo G, Barabino M, Ghilardi G, Masserano R, Lecchi F, Piozzi GN, Bianchi PP. Detection and Real-Time Surgical Assessment of Colorectal Liver Metastases Using Near-Infrared Fluorescence Imaging during Laparoscopic and Robotic-Assisted Resections. Cancers (Basel) 2024; 16:1641. [PMID: 38730593 PMCID: PMC11083015 DOI: 10.3390/cancers16091641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 04/19/2024] [Accepted: 04/20/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND The European Association of Endoscopic Surgery (EAES) recommends, with strong evidence, the use of indocyanine green (ICG) fluorescence imaging combined with intraoperative ultrasound (IOUS) to improve identification of superficial liver tumors. This study reports the use of ICG for the detection of colorectal liver metastases (CRLMs) during minimally invasive liver resection. METHODS A single-center consecutive series of minimally invasive (laparoscopic and robotic) hepatic resections for CRLMs was prospectively evaluated (April 2019 and October 2023). RESULTS A total of 25 patients were enrolled-11 undergoing laparoscopic and 14 undergoing robotic procedures. The median age was 65 (range 50-85) years. Fifty CRLMs were detected: twenty superficial, eight exophytic, seven shallow (<8 mm from the hepatic surface), and fifteen deep (>10 mm from the hepatic surface) lesions. The detection rates of CRLMs through preoperative imaging, laparoscopic ultrasound (LUS), ICG fluorescence, and combined modalities (ICG and LUS) were 88%, 90%, 68%, and 100%, respectively. ICG fluorescence staining allowed us to detect five small additional superficial lesions (not identified with other preoperative/intraoperative techniques). However, two lesions were false positive fluorescence accumulations. All rim fluorescence pattern lesions were CRLMs. ICG fluorescence was used as a real-time guide to assess surgical margins during parenchymal-sparing liver resections. All patients with integrity of the fluorescent rim around the CRLM displayed a radical resection during histopathological analysis. Four patients (8%) with a protruding rim or residual rim patterns had positive resection margins. CONCLUSIONS ICG fluorescence imaging can be integrated with other conventional intraoperative imaging techniques to optimize intraoperative staging. Rim fluorescence proved to be a valid indicator of the resection margins: by removing the entire fluorescent area, a tumor-negative resection (R0) is achieved.
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Affiliation(s)
- Gaetano Piccolo
- General Surgery Unit, Department of Health Sciences (DISS), San Paolo Hospital, University of Milan, 20142 Milano, Italy; (G.P.); (G.G.); (R.M.); (F.L.); (P.P.B.)
| | - Matteo Barabino
- General Surgery Unit, Department of Health Sciences (DISS), San Paolo Hospital, University of Milan, 20142 Milano, Italy; (G.P.); (G.G.); (R.M.); (F.L.); (P.P.B.)
| | - Giorgio Ghilardi
- General Surgery Unit, Department of Health Sciences (DISS), San Paolo Hospital, University of Milan, 20142 Milano, Italy; (G.P.); (G.G.); (R.M.); (F.L.); (P.P.B.)
| | - Riccardo Masserano
- General Surgery Unit, Department of Health Sciences (DISS), San Paolo Hospital, University of Milan, 20142 Milano, Italy; (G.P.); (G.G.); (R.M.); (F.L.); (P.P.B.)
| | - Francesca Lecchi
- General Surgery Unit, Department of Health Sciences (DISS), San Paolo Hospital, University of Milan, 20142 Milano, Italy; (G.P.); (G.G.); (R.M.); (F.L.); (P.P.B.)
| | - Guglielmo Niccolò Piozzi
- Department of Colorectal Surgery, Portsmouth Hospitals University NHS Trust, Portsmouth PO6 3LY, UK;
| | - Paolo Pietro Bianchi
- General Surgery Unit, Department of Health Sciences (DISS), San Paolo Hospital, University of Milan, 20142 Milano, Italy; (G.P.); (G.G.); (R.M.); (F.L.); (P.P.B.)
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14
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Kalayarasan R, Chandrasekar M, Sai Krishna P, Shanmugam D. Indocyanine green fluorescence in gastrointestinal surgery: Appraisal of current evidence. World J Gastrointest Surg 2023; 15:2693-2708. [PMID: 38222003 PMCID: PMC10784830 DOI: 10.4240/wjgs.v15.i12.2693] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/12/2023] [Accepted: 11/09/2023] [Indexed: 12/27/2023] Open
Abstract
Applying indocyanine green (ICG) fluorescence in surgery has created a new dimension of navigation surgery to advance in various disciplines. The research in this field is nascent and fragmented, necessitating academic efforts to gain a comprehensive understanding. The present review aims to integrate diverse perspectives and recent advances in its application in gastrointestinal surgery. The relevant articles were selected by using the appropriate keyword search in PubMed. The angiography and cholangiography property of ICG fluorescence is helpful in various hepatobiliary disorders. In gastroesophageal and colorectal surgery, the lymphangiography and angiography property of ICG is applied to evaluate bowel vascularity and guide lymphadenectomy. The lack of objective parameters to assess ICG fluorescence has been the primary limitation when ICG is used to evaluate bowel perfusion. The optimum dose and timing of ICG administration need to be standardized in some new application areas in gastrointestinal surgery. Binding tumor-specific ligands with fluorophores can potentially widen the fluorescence application to detect primary and metastatic gastrointestinal tumors. The narrative review outlines prior contributions, limitations, and research opportunities for future studies across gastrointestinal sub-specialty. The findings of the present review would be helpful for scholars and practitioners to explore and progress in this exciting domain of gastrointestinal surgery.
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Affiliation(s)
- Raja Kalayarasan
- Department of Surgical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry 605006, India
| | - Murugesan Chandrasekar
- Department of Surgical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry 605006, India
| | - Pothugunta Sai Krishna
- Department of Surgical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry 605006, India
| | - Dasarathan Shanmugam
- Department of Surgical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry 605006, India
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15
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Sandor Z, Ujfalusi Z, Varga A. Application of a Self-developed, Low-budget Indocyanine Green Camera in Surgical Imaging - a Single Institution's Experiences. J Fluoresc 2023; 33:2099-2103. [PMID: 36988781 PMCID: PMC10539407 DOI: 10.1007/s10895-023-03224-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 03/21/2023] [Indexed: 03/30/2023]
Abstract
INTRODUCTION Indocyanine green is a fluorescent dye, the use of which is becoming more and more widespread in different areas of surgery. Several international studies deal with the dye's usefulness in intraoperative angiography, the localization of tumors, the more precise identification of anatomical structures, the detection of lymph nodes and lymph ducts, etc. The application of the dye is safe, but a suitable equipment park is required for its use, which entails relatively high costs. OBJECTIVES The aim of our research is to create a detector system on a low budget, to be used safely in everyday practice and to illustrate its operation with practical examples at our own institute. METHODS By modifying a web camera, using filter lenses and special LEDs, we created a device suitable for exciting and detecting indocyanine green fluorescence. We prove its excellent versatility during the following procedures at our institute: breast tumor surgery, kidney transplantation, bowel resection, parathyroid surgery and liver tumor resection. RESULTS The finished camera has an LED light source with a peak wavelength of 780 nm, and the incoming light is filtered by a bandpass filter with a center wavelength of 832 nm. A low budget ($112), easy-to-use tool was created, which is suitable for taking advantage of the opportunities provided by indocyanine green.
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Affiliation(s)
- Zoltan Sandor
- Department of Surgery, University of Pécs, Pécs, Hungary
| | | | - Adam Varga
- Department of Surgery, University of Pécs, Pécs, Hungary.
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16
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Cai X, Hong H, Chen Y. ASO Author Reflections: The Application of ICG Fluorescent Staining in Laparoscopic Hepatectomy for Liver Malignancies is More Beneficial to Ensure Radical Surgery. Ann Surg Oncol 2023; 30:1988-1989. [PMID: 36528747 DOI: 10.1245/s10434-022-12951-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 12/02/2022] [Indexed: 12/23/2022]
Affiliation(s)
- Xinran Cai
- Department of Hepatobiliary Surgery and Fujian Institute of Hepatobiliary Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Fujian Medical University Cancer Center, Fuzhou, Minhou, China
- Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Minhou, China
- Fujian Key Laboratory of Tumor Microbiology, Department of Medical Microbiology, Fujian Medical University, Fuzhou, Minhou, China
| | - Haijie Hong
- Department of Hepatobiliary Surgery and Fujian Institute of Hepatobiliary Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
- Fujian Medical University Cancer Center, Fuzhou, Minhou, China.
- Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Minhou, China.
- Fujian Key Laboratory of Tumor Microbiology, Department of Medical Microbiology, Fujian Medical University, Fuzhou, Minhou, China.
| | - Yanling Chen
- Department of Hepatobiliary Surgery and Fujian Institute of Hepatobiliary Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
- Fujian Medical University Cancer Center, Fuzhou, Minhou, China.
- Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Minhou, China.
- Fujian Key Laboratory of Tumor Microbiology, Department of Medical Microbiology, Fujian Medical University, Fuzhou, Minhou, China.
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17
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Zagainov EV, Karachun AM, Sapronov PA, Khromova EA, Kazantsev AI. [Modern possibilities of fluorescent imaging in liver surgery]. Khirurgiia (Mosk) 2023:98-106. [PMID: 37916563 DOI: 10.17116/hirurgia202310198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
The article presents a literature review of modern methods of fluorescent navigation in liver surgery. The technique of tumor «staining», mapping of liver segments, fluorescent cholangiography is covered. The own results of the use of indocyanine green in liver surgery are presented.
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Affiliation(s)
- E V Zagainov
- FSBI «National Medical Research Center of Oncology named after N.N. Petrov» of the Ministry of Health of Russia, St. Petersburg, Russia
| | - A M Karachun
- FSBI «National Medical Research Center of Oncology named after N.N. Petrov» of the Ministry of Health of Russia, St. Petersburg, Russia
| | - P A Sapronov
- FSBI «National Medical Research Center of Oncology named after N.N. Petrov» of the Ministry of Health of Russia, St. Petersburg, Russia
| | - E A Khromova
- FSBI «National Medical Research Center of Oncology named after N.N. Petrov» of the Ministry of Health of Russia, St. Petersburg, Russia
| | - A I Kazantsev
- FSBI «National Medical Research Center of Oncology named after N.N. Petrov» of the Ministry of Health of Russia, St. Petersburg, Russia
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