TY - JOUR
T1 - Laparoscopic detection and resection of occult liver tumors of multiple cancer types using real-time near-infrared fluorescence guidance
AU - Boogerd, Leonora S.F.
AU - Handgraaf, Henricus J.M.
AU - Lam, Hwai Ding
AU - Huurman, Volkert A.L.
AU - Farina-Sarasqueta, Arantza
AU - Frangioni, John V.
AU - van de Velde, Cornelis J.H.
AU - Braat, Andries E.
AU - Vahrmeijer, Alexander L.
N1 - Funding Information: Funding This work was supported in part by the Dutch Cancer Society Grant UL2010-4732 and National Institutes of Health Grant R01-CA-115296. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Funding Information: The authors gratefully acknowledge H.A.J.M. Prevoo for her support and immunohistochemical expertise. We thank David J. Burrington Jr. for editing. This work was supported in part by the Dutch Cancer Society Grant UL2010-4732 and National Institutes of Health Grant R01-CA-115296. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Publisher Copyright: © 2016, The Author(s).
PY - 2017/2/1
Y1 - 2017/2/1
N2 - Background: Tumor recurrence after radical resection of hepatic tumors is not uncommon, suggesting that malignant lesions are missed during surgery. Intraoperative navigation using fluorescence guidance is an innovative technique enabling real-time identification of (sub)capsular liver tumors. The objective of the current study was to compare fluorescence imaging (FI) and conventional imaging modalities for laparoscopic detection of both primary and metastatic tumors in the liver. Methods: Patients undergoing laparoscopic resection of a malignant hepatic tumor were eligible for inclusion. Patients received standard of care, including preoperative CT and/or MRI. In addition, 10 mg indocyanine green was intravenously administered 1 day prior to surgery. After introduction of the laparoscope, inspection, FI, and laparoscopic ultrasonography (LUS) were performed. Histopathological examination of resected suspect tissue was considered the gold standard. Results: Twenty-two patients suspected of having hepatocellular carcinoma (n = 4), cholangiocarcinoma (n = 2) or liver metastases from colorectal carcinoma (n = 12), uveal melanoma (n = 2), and breast cancer (n = 2) were included. Two patients were excluded because their surgery was unexpectedly postponed several days. Twenty-six malignancies were resected in the remaining 20 patients. Sensitivity for various modalities was 80 % (CT), 84 % (MRI), 62 % (inspection), 86 % (LUS), and 92 % (FI), respectively. Three metastases (12 %) were identified solely by FI. All 26 malignancies could be detected by combining LUS and FI (100 % sensitivity). Conclusion: This study demonstrates added value of FI during laparoscopic resections of several hepatic tumors. Although larger series will be needed to confirm long-term patient outcome, the technology already aids the surgeon by providing real-time fluorescence guidance.
AB - Background: Tumor recurrence after radical resection of hepatic tumors is not uncommon, suggesting that malignant lesions are missed during surgery. Intraoperative navigation using fluorescence guidance is an innovative technique enabling real-time identification of (sub)capsular liver tumors. The objective of the current study was to compare fluorescence imaging (FI) and conventional imaging modalities for laparoscopic detection of both primary and metastatic tumors in the liver. Methods: Patients undergoing laparoscopic resection of a malignant hepatic tumor were eligible for inclusion. Patients received standard of care, including preoperative CT and/or MRI. In addition, 10 mg indocyanine green was intravenously administered 1 day prior to surgery. After introduction of the laparoscope, inspection, FI, and laparoscopic ultrasonography (LUS) were performed. Histopathological examination of resected suspect tissue was considered the gold standard. Results: Twenty-two patients suspected of having hepatocellular carcinoma (n = 4), cholangiocarcinoma (n = 2) or liver metastases from colorectal carcinoma (n = 12), uveal melanoma (n = 2), and breast cancer (n = 2) were included. Two patients were excluded because their surgery was unexpectedly postponed several days. Twenty-six malignancies were resected in the remaining 20 patients. Sensitivity for various modalities was 80 % (CT), 84 % (MRI), 62 % (inspection), 86 % (LUS), and 92 % (FI), respectively. Three metastases (12 %) were identified solely by FI. All 26 malignancies could be detected by combining LUS and FI (100 % sensitivity). Conclusion: This study demonstrates added value of FI during laparoscopic resections of several hepatic tumors. Although larger series will be needed to confirm long-term patient outcome, the technology already aids the surgeon by providing real-time fluorescence guidance.
KW - Fluorescence imaging
KW - Hepatic metastases
KW - Indocyanine green
KW - Intraoperative guidance
KW - Surgical navigation
KW - Tumor imaging
UR - http://www.scopus.com/inward/record.url?scp=84976412610&partnerID=8YFLogxK
U2 - https://doi.org/10.1007/s00464-016-5007-6
DO - https://doi.org/10.1007/s00464-016-5007-6
M3 - Article
C2 - 27357928
SN - 0930-2794
VL - 31
SP - 952
EP - 961
JO - Surgical endoscopy
JF - Surgical endoscopy
IS - 2
ER -