Combined use of intraoperative ultrasound and indocyanine green fluorescence imaging to detect liver metastases from colorectal cancer. Issue 12 (20th February 2013)

• Record Type: Journal Article
• Authors: Peloso, Andrea; Franchi, Eloisa; Canepa, Maria C.; Barbieri, Letizia; Briani, Laura; Ferrario, Jacopo; Bianco, Carolina; Quaretti, Pietro; Brugnatelli, Silvia; Dionigi, Paolo; Maestri, Marcello
• Is Part Of: HPB. Volume 15:Issue 12(2013:Dec.)
• Page Start: 928
• Page End: 934
• Publication Date: 2013-02-20
• Subjects: Liver -- Diseases -- Periodicals; Biliary tract -- Diseases -- Periodicals; Pancreas -- Diseases -- Periodicals; 616.362005
• DOI: 10.1111/hpb.12057
• Languages: English
• ISSNs: 1365-182X

Abstract

Abstract: Objectives: Surgical excision is the standard strategy for managing liver metastases from colorectal carcinoma. The achievement of negative (R0) margins is a major determinant of disease‐free survival in these patients. Current imaging techniques are of limited value in achieving this goal. A new approach to the intraoperative detection of colorectal liver metastatic tissue based on the emission of indocyanine green (ICG) fluorescence was evaluated. Methods: A total of 25 consecutive patients with liver metastases from primary colorectal cancers who were eligible for liver resection received a bolus of ICG (0.5 mg/kg body weight) 24 h before surgery. During surgery, ICG fluorescence, which accumulates around lesions as a result of defective biliary clearance, was detected with a near‐infrared camera system, the Photodynamic Eye (PDE). Numbers of lesions detected by, respectively, PDE + ICG, intraoperative ultrasound (IOUS) and preoperative computed tomography (CT) were recorded. Results: The near‐infrared camera plus ICG revealed a total of 77 metastatic liver nodules. Preoperative CT demonstrated 45 (58.4%) and IOUS showed 55 (71.4%). Preoperative CT and IOUS alone were inferior to the combined use of PDE + ICG and IOUS in the detection of lesions of ≤3 mm in size. Conclusions: This experience suggests that PDE + ICG, combined with IOUS, may represent a safe and effective tool for ensuring the complete surgical eradication of liver metastases from colorectal cancer.