红外吲哚菁绿荧光成像引导的腹腔镜肝切除术对确保结直肠肝转移灶切除边缘的影响

Toru Kato, Masafumi Imamura, Daisuke Kyuno, Yasutoshi Kimura, Kazuharu Kukita, Takeshi Murakami, Eiji Yoshida, Toru Mizuguchi, Ichiro Takemasa
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引用次数: 0

摘要

背景:腹腔镜肝切除术治疗结直肠肝转移瘤(CRLM)在全球范围内广泛开展。然而,由于缺乏触诊信息以及术中超声波准确诊断的困难,肿瘤可能暴露在肝横切缘处。本研究旨在探讨吲哚菁绿(ICG)引导下腹腔镜肝切除术的近红外(NIR)荧光成像的病理学意义,并确定其在确保CRLMs切除边缘方面的作用:纳入2017年2月至2021年6月期间在札幌医科大学附属医院使用近红外荧光成像对CRLM进行腹腔镜肝切除术的59例患者。一般情况下,所有患者在术前1至2天静脉注射ICG(2.5毫克/体)作为荧光剂。在手术过程中,反复进行实时近红外荧光成像以评估手术边缘:结果:在59名患者的94个肿瘤中,腹腔镜近红外荧光成像在肝脏表面发现了56个肿瘤(59.6%)。病理分析显示,96.6%(57/59)的患者边缘清晰。对石蜡包埋切片的检查显示,94 例患者中仅有 20 例(21.3%)成功进行了近红外荧光成像,没有肿瘤细胞呈阳性,连续荧光信号距离肿瘤边缘的中位距离为 1.074 毫米:结论:我们证明了近红外荧光引导肝切除术的高R0率。这项技术有望提高术中肿瘤识别率和肿瘤边缘保证率,降低 CRLM 患者切除边缘阳性率。
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Impact of Infrared Indocyanine Green Fluorescence imaging-guided Laparoscopic Hepatectomy on Securing the Resection Margin for Colorectal Liver Metastasis.

Background: Laparoscopic hepatectomy for colorectal liver metastases (CRLM) is performed worldwide. However, owing to a lack of palpatory information and difficulties associated with accurate intraoperative ultrasonographic diagnosis, the tumor may be exposed at the hepatic transection margin. This study aimed to investigate the pathological significance of near-infrared (NIR) fluorescence imaging with indocyanine green (ICG)-guided laparoscopic hepatectomy and determine its usefulness in securing the resection margin for CRLMs.

Methods: Fifty-nine patients who underwent laparoscopic hepatectomy for CRLM using NIR fluorescence imaging between February 2017 and June 2021 at Sapporo Medical University Hospital were included. Generally, all patients received intravenous ICG (2.5 mg/body) as a fluorescence agent 1 to 2 days before surgery. During the surgical procedure, real-time NIR fluorescence imaging was repeatedly performed to assess the surgical margins.

Results: Of the 94 tumors in 59 patients, laparoscopic NIR fluorescence imaging identified 56 tumors (59.6%) on the liver surface. Pathological analysis indicated clear margins in 96.6% (57/59) of patients. Examination of paraffin-embedded sections, which were successful in only 20 of 94 cases (21.3%), revealed that there were no tumor cells positive for NIR fluorescence, and the median distance of the continuous fluorescent signal from the tumor margin was 1.074 mm.

Conclusions: We demonstrated a high R0 rate using NIR fluorescence-guided hepatectomy. This technique has the potential to improve intraoperative tumor identification and tumor margin assurance and reduce the rate of positive resection margins in patients with CRLMs.

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来源期刊
CiteScore
2.00
自引率
10.00%
发文量
103
审稿时长
3-8 weeks
期刊介绍: Surgical Laparoscopy Endoscopy & Percutaneous Techniques is a primary source for peer-reviewed, original articles on the newest techniques and applications in operative laparoscopy and endoscopy. Its Editorial Board includes many of the surgeons who pioneered the use of these revolutionary techniques. The journal provides complete, timely, accurate, practical coverage of laparoscopic and endoscopic techniques and procedures; current clinical and basic science research; preoperative and postoperative patient management; complications in laparoscopic and endoscopic surgery; and new developments in instrumentation and technology.
期刊最新文献
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