Marie Sophie Alfano1, Sarah Molfino2,3, Sara Benedicenti1, Beatrice Molteni1, Paola Porsio1, Elisa Arici1, Federico Gheza4, Maristella Botticini5, Nazario Portolani1,6, Gian Luca Baiocchi1,6. 1. 3rd Division of General Surgery, Spedali Civili di Brescia, P.le Spedali Civili 1, Brescia, Italy. 2. 3rd Division of General Surgery, Spedali Civili di Brescia, P.le Spedali Civili 1, Brescia, Italy. sarahmolfino@gmail.com. 3. Department of Clinical and Experimental Sciences, Surgical Clinic, University of Brescia, Brescia, Italy. sarahmolfino@gmail.com. 4. Division of Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, USA. 5. IGIER Università Bocconi, Milano, Italy. 6. Department of Clinical and Experimental Sciences, Surgical Clinic, University of Brescia, Brescia, Italy.
Abstract
BACKGROUND: Detecting small nodules that are grossly unidentifiable remains a major challenge in liver resection for cancer. Novel developments in navigation surgery, especially indocyanine green (ICG)-based fluorescence imaging, are making a clear breakthrough in addressing this issue. ICG is almost routinely administered during the preoperative stage in hepatobiliary surgery. However, its full potential has yet to be realized, partly because there are no precise guidelines regarding the optimal dose or timing of ICG injections before liver surgery. The main goal of this study was to design an algorithm for the management of ICG injections to achieve optimal liver staining results. METHODS: Twenty-seven consecutive, unselected patients undergoing liver resection for cancer were enrolled and underwent preoperative liver function assessment by the LiMON test. Extra ICG i.v. injections at different doses and timings were performed. In vivo intraoperative analysis of the stain detected by near-infrared fluorescence imaging of the liver and ex vivo analysis of each resected nodule was performed and compared to the pathological analysis. RESULTS: (i) The success rate of ICG injections in terms of liver staining was 92.6%; (ii) in the absence of or with 7 or more days from a previous ICG injection, the best dose to inject before the operation was 0.2 mg/kg, and the best timing was between 24 and 48 h before the scheduled surgery; and (iii) the ICG fluorescence patterns observed in the tumors were total fluorescence staining (41% of the cases), partial fluorescence staining (15%), rim fluorescence staining surrounding the tumor (30%), and no staining (15%). CONCLUSIONS: This study is a building block for the characterization of liver nodules and the search for additional surface lesions undetected by preoperative radiological work-up-a crucial task for the successful treatment of liver cancer at an early stage using a safe, minimally invasive, and inexpensive technique.
BACKGROUND: Detecting small nodules that are grossly unidentifiable remains a major challenge in liver resection for cancer. Novel developments in navigation surgery, especially indocyanine green (ICG)-based fluorescence imaging, are making a clear breakthrough in addressing this issue. ICG is almost routinely administered during the preoperative stage in hepatobiliary surgery. However, its full potential has yet to be realized, partly because there are no precise guidelines regarding the optimal dose or timing of ICG injections before liver surgery. The main goal of this study was to design an algorithm for the management of ICG injections to achieve optimal liver staining results. METHODS: Twenty-seven consecutive, unselected patients undergoing liver resection for cancer were enrolled and underwent preoperative liver function assessment by the LiMON test. Extra ICG i.v. injections at different doses and timings were performed. In vivo intraoperative analysis of the stain detected by near-infrared fluorescence imaging of the liver and ex vivo analysis of each resected nodule was performed and compared to the pathological analysis. RESULTS: (i) The success rate of ICG injections in terms of liver staining was 92.6%; (ii) in the absence of or with 7 or more days from a previous ICG injection, the best dose to inject before the operation was 0.2 mg/kg, and the best timing was between 24 and 48 h before the scheduled surgery; and (iii) the ICG fluorescence patterns observed in the tumors were total fluorescence staining (41% of the cases), partial fluorescence staining (15%), rim fluorescence staining surrounding the tumor (30%), and no staining (15%). CONCLUSIONS: This study is a building block for the characterization of liver nodules and the search for additional surface lesions undetected by preoperative radiological work-up-a crucial task for the successful treatment of liver cancer at an early stage using a safe, minimally invasive, and inexpensive technique.
Authors: T Abo; A Nanashima; S Tobinaga; S Hidaka; N Taura; K Takagi; J Arai; H Miyaaki; H Shibata; T Nagayasu Journal: Eur J Surg Oncol Date: 2014-10-18 Impact factor: 4.424
Authors: Anne-Sophie Mehdorn; Florian Richter; Katharina Hess; Jan Henrik Beckmann; Jan-Hendrik Egberts; Michael Linecker; Thomas Becker; Felix Braun Journal: J Clin Med Date: 2022-06-19 Impact factor: 4.964
Authors: Anne-Sophie Mehdorn; Jan Henrik Beckmann; Felix Braun; Thomas Becker; Jan-Hendrik Egberts Journal: J Clin Med Date: 2021-01-25 Impact factor: 4.241
Authors: Gian Luca Baiocchi; Gianluca Guercioni; Nereo Vettoretto; Stefano Scabini; Paolo Millo; Andrea Muratore; Marco Clementi; Giuseppe Sica; Paolo Delrio; Graziano Longo; Gabriele Anania; Vittoria Barbieri; Pietro Amodio; Carlo Di Marco; Gianandrea Baldazzi; Gianluca Garulli; Alberto Patriti; Felice Pirozzi; Raffaele De Luca; Stefano Mancini; Corrado Pedrazzani; Matteo Scaramuzzi; Marco Scatizzi; Lucio Taglietti; Michele Motter; Graziano Ceccarelli; Mauro Totis; Andrea Gennai; Diletta Frazzini; Gianluca Di Mauro; Gabriella Teresa Capolupo; Francesco Crafa; Pierluigi Marini; Giacomo Ruffo; Roberto Persiani; Felice Borghi; Nicolò de Manzini; Marco Catarci Journal: BMC Surg Date: 2021-04-10 Impact factor: 2.102