Laparoscopic detection and resection of occult liver tumors of multiple cancer types using real-time near-infrared fluorescence guidance.
Laparoscopic detection and resection of occult liver tumors of multiple cancer types using real-time near-infrared fluorescence guidance.
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DOI：
10.1007/s00464-016-5007-6
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发表时间：
2017-02
影响因子：
3.1
通讯作者：
Vahrmeijer, Alexander L.
中科院分区：
文献类型：
--
作者：
Boogerd, Leonora S. F.;Handgraaf, Henricus J. M.;Lam, Hwai-Ding;Huurman, Volkert A. L.;Farina-Sarasqueta, Arantza;Frangioni, John V.;van de Velde, Cornelis J. H.;Braat, Andries E.;Vahrmeijer, Alexander L.
关键词：
肝肿瘤根治性切除术后肿瘤复发并不少见，这表明恶性病变在手术中被遗漏。使用荧光引导的术中导航是一种能够实时识别（下）包膜肝肿瘤的创新技术。本研究的目的是比较荧光成像（FI）和传统的成像方式腹腔镜检测原发性和转移性肿瘤在肝脏。接受腹腔镜切除恶性肝肿瘤的患者有资格入选。患者接受标准治疗，包括术前CT和/或MRI。此外，在手术前1天静脉内给予10 mg吲哚菁绿色。引入腹腔镜后，进行了检查、FI和腹腔镜超声检查（LUS）。切除的可疑组织的组织学检查被认为是金标准。纳入了22例疑似肝细胞癌（n = 4）、胆管癌（n = 2）或结直肠癌肝转移（n = 12）、葡萄膜黑色素瘤（n = 2）和乳腺癌（n = 2）的患者。两名患者被排除在外，因为他们的手术意外推迟了几天。其余20例患者切除了26例恶性肿瘤。各种模式的灵敏度分别为80%（CT）、84%（MRI）、62%（检查）、86%（LUS）和92%（FI）。仅通过FI确定了3个转移灶（12%）。LUS和FI联合应用可检出所有26例恶性肿瘤（100%敏感性）.本研究证明了FI在腹腔镜切除几种肝脏肿瘤中的附加价值。虽然需要更大的系列来确认患者的长期结果，但该技术已经通过提供实时荧光引导来帮助外科医生。本文的在线版本（doi：10.1007/s 00464 -016-5007-6）包含补充材料，可供授权用户使用。
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. 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. 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). 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. The online version of this article (doi:10.1007/s00464-016-5007-6) contains supplementary material, which is available to authorized users.
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影响因子：
1.5
作者：
Tummers QR;Verbeek FP;Prevoo HA;Braat AE;Baeten CI;Frangioni JV;van de Velde CJ;Vahrmeijer AL
通讯作者：
Vahrmeijer AL
影响因子：
2.9
作者：
Franssen, Bernardo;Jibara, Ghalib;Roayaie, Sasan
通讯作者：
Roayaie, Sasan
影响因子：
6.2
作者：
Ishizawa, Takeaki;Fukushima, Noriyoshi;Kokudo, Norihiro
通讯作者：
Kokudo, Norihiro
影响因子：
2.4
作者：
Smith, J. Joshua;D'Angelica, Michael I.
通讯作者：
D'Angelica, Michael I.
影响因子：
3.4
作者：
Fengler, J.
通讯作者：
Fengler, J.