AI Article Synopsis
- Pulmonary metastasectomy for hepatocellular carcinoma (HCC) can be effective but challenging, particularly with multiple lung metastases; this study explores the benefits of using indocyanine green (ICG) fluorescence imaging for surgery.
- A total of 15 HCC patients underwent surgery where 90 metastatic nodules were resected, successfully identifying many lesions via near-infrared fluorescence imaging, although some went undetected.
- Results showed a median overall survival of 47.1 months, indicating that ICG fluorescence can improve visualization and potentially assist in resecting small tumors that preoperative assessments might miss.
Article Abstract
Objectives: Pulmonary metastasectomy for hepatocellular carcinoma (HCC) is suitable in highly selected patients. However, complete resection is challenging in HCC patients with multiple lung metastases. We aimed to describe the clinical utility and survival outcome of indocyanine green (ICG) fluorescence-navigated resection of HCC lung metastases.
Methods: From October 2015 to March 2021, 15 HCC patients with pulmonary metastasis underwent near-infra-red (NIR) fluorescence imaging thoracoscopic surgery. ICG was administered through peripheral veins preoperatively. All suspected lesions detected by palpation, white-light thoracoscopy or NIR imaging were resected. After metastasectomy, all patients were followed up at regular intervals of 6-12 months.
Results: A total of 90 metastatic HCC nodules were resected in 15 patients. All patients received sublobar resections, during which 89 lesions were removed by wedge resection and 1 lesion was managed via segmentectomy. Under NIR fluorescence imaging, 81 nodules successfully demonstrated fluorescence during the surgery, while 9 metastatic nodules were undetected. The median signal-to-background ratio of the nodules was 3.34. Five patients died and 7 patients relapsed by the end of observation. The median overall survival and disease-free survival were 47.1 and 17.3 months, respectively. The 1-year overall survival and disease-free survival rates were 71.1% and 57.8%, respectively.
Conclusions: ICG fluorescence imaging technology is useful for visualization of the peripheral tumours to assist in pulmonary metastasectomy for HCC. In addition, this technology has the potential to detect the small tumour that is missed in preoperative examinations, which might be beneficial for HCC patients with multiple lung metastases.
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| http://dx.doi.org/10.1093/ejcts/ezac270 | DOI Listing |
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