Indocyanine Green Fluorescence for Liver Assessment and Imaging-Guided Resection of Colorectal Metastases: A Case Report

Abstract Introduction Liver resection is widely accepted as a treatment option for primary liver cancer and metastases. The goal of surgery is to resect all tumours with negative histological margins while preserving sufficient functional hepatic parenchyma and reducing postoperative complications. The use of Indocyanine green (ICG) for liver function assessment and fluorescence image-guided surgery could be used to achieve that goal. Clinical Case Description We present the case of a 62-year-old female patient with diagnosed sigmoid colon cancer with four bilobar liver metastases who underwent a simultaneous sigmoid resection and ICG fluorescence image-guided liver resection 3 days after preoperative ICG liver function assessment. We decided to perform liver-sparing resection having in mind the liver metastases’ number, size and location and the slightly impaired liver function (ICG retention rate 15 – ICGR15 was 14,02%). All liver tumours were removed without complications, and the resected margins were all microscopically free of tumour tissue (R0 resection). The postoperative period was uneventful, without any signs of postoperative liver failure. Conclusions ICGR15 can be considered a safe and informative marker for liver function and indirectly for the degree of portal hypertension. ICG fluorescence provides an additional method to assist intra-operative tumour identification. The best timing of injection requires further study.