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Open Access 01-02-2017 | Dynamic Manuscript

Laparoscopic detection and resection of occult liver tumors of multiple cancer types using real-time near-infrared fluorescence guidance

Authors: Leonora S. F. Boogerd, Henricus J. M. Handgraaf, Hwai-Ding Lam, Volkert A. L. Huurman, Arantza Farina-Sarasqueta, John V. Frangioni, Cornelis J. H. van de Velde, Andries E. Braat, Alexander L. Vahrmeijer

Published in: Surgical Endoscopy | Issue 2/2017

Abstract

Background

Tumor recurrence after radical resection of hepatic tumors is not uncommon, suggesting that malignant lesions are missed during surgery. Intraoperative navigation using fluorescence guidance is an innovative technique enabling real-time identification of (sub)capsular liver tumors. The objective of the current study was to compare fluorescence imaging (FI) and conventional imaging modalities for laparoscopic detection of both primary and metastatic tumors in the liver.

Methods

Patients undergoing laparoscopic resection of a malignant hepatic tumor were eligible for inclusion. Patients received standard of care, including preoperative CT and/or MRI. In addition, 10 mg indocyanine green was intravenously administered 1 day prior to surgery. After introduction of the laparoscope, inspection, FI, and laparoscopic ultrasonography (LUS) were performed. Histopathological examination of resected suspect tissue was considered the gold standard.

Results

Twenty-two patients suspected of having hepatocellular carcinoma (n = 4), cholangiocarcinoma (n = 2) or liver metastases from colorectal carcinoma (n = 12), uveal melanoma (n = 2), and breast cancer (n = 2) were included. Two patients were excluded because their surgery was unexpectedly postponed several days. Twenty-six malignancies were resected in the remaining 20 patients. Sensitivity for various modalities was 80 % (CT), 84 % (MRI), 62 % (inspection), 86 % (LUS), and 92 % (FI), respectively. Three metastases (12 %) were identified solely by FI. All 26 malignancies could be detected by combining LUS and FI (100 % sensitivity).

Conclusion

This study demonstrates added value of FI during laparoscopic resections of several hepatic tumors. Although larger series will be needed to confirm long-term patient outcome, the technology already aids the surgeon by providing real-time fluorescence guidance.

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Title: Laparoscopic detection and resection of occult liver tumors of multiple cancer types using real-time near-infrared fluorescence guidance
Authors: Leonora S. F. Boogerd
Henricus J. M. Handgraaf
Hwai-Ding Lam
Volkert A. L. Huurman
Arantza Farina-Sarasqueta
John V. Frangioni
Cornelis J. H. van de Velde
Andries E. Braat
Alexander L. Vahrmeijer
Publication date: 01-02-2017
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 2/2017
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-016-5007-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Laparoscopic detection and resection of occult liver tumors of multiple cancer types using real-time near-infrared fluorescence guidance

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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