Background: The European Association of Endoscopic Surgery (EAES) recommends, with strong evidence, the use of indocyanine green (ICG) fluorescence imaging combined with intraoperative ultrasound (IOUS) to improve identification of superficial liver tumors. This study reports the use of ICG for the detection of colorectal liver metastases (CRLMs) during minimally invasive liver resection. Methods: A single-center consecutive series of minimally invasive (laparoscopic and robotic) hepatic resections for CRLMs was prospectively evaluated (April 2019 and October 2023). Results: A total of 25 patients were enrolled—11 undergoing laparoscopic and 14 undergoing robotic procedures. The median age was 65 (range 50–85) years. Fifty CRLMs were detected: twenty superficial, eight exophytic, seven shallow (<8 mm from the hepatic surface), and fifteen deep (>10 mm from the hepatic surface) lesions. The detection rates of CRLMs through preoperative imaging, laparoscopic ultrasound (LUS), ICG fluorescence, and combined modalities (ICG and LUS) were 88%, 90%, 68%, and 100%, respectively. ICG fluorescence staining allowed us to detect five small additional superficial lesions (not identified with other preoperative/intraoperative techniques). However, two lesions were false positive fluorescence accumulations. All rim fluorescence pattern lesions were CRLMs. ICG fluorescence was used as a real-time guide to assess surgical margins during parenchymal-sparing liver resections. All patients with integrity of the fluorescent rim around the CRLM displayed a radical resection during histopathological analysis. Four patients (8%) with a protruding rim or residual rim patterns had positive resection margins. Conclusions: ICG fluorescence imaging can be integrated with other conventional intraoperative imaging techniques to optimize intraoperative staging. Rim fluorescence proved to be a valid indicator of the resection margins: by removing the entire fluorescent area, a tumor-negative resection (R0) is achieved.
背景：欧洲内镜外科协会（EAES）基于强有力的证据，推荐使用吲哚菁绿（ICG）荧光成像联合术中超声（IOUS）以提高表浅肝脏肿瘤的识别率。本研究报道了在微创肝切除术中使用ICG检测结直肠癌肝转移（CRLMs）的情况。方法：前瞻性评估了单中心连续进行的微创（腹腔镜和机器人）肝切除术治疗CRLMs的病例系列（2019年4月至2023年10月）。结果：共纳入25例患者，其中11例接受腹腔镜手术，14例接受机器人手术。中位年龄为65岁（范围50-85岁）。共检测到50个CRLMs病灶：20个为表浅型，8个为外生型，7个为浅表型（距肝表面<8 mm），15个为深部型（距肝表面>10 mm）。通过术前影像学、腹腔镜超声（LUS）、ICG荧光以及联合模式（ICG和LUS）检测CRLMs的检出率分别为88%、90%、68%和100%。ICG荧光染色使我们检测到5个额外的表浅小病灶（其他术前/术中技术未识别）。然而，有2个病灶为假阳性荧光积聚。所有呈现边缘荧光模式的病灶均为CRLMs。在保留肝实质的肝切除术中，ICG荧光被用作实时引导以评估手术切缘。所有CRLM周围荧光环完整的患者在组织病理学分析中均显示为根治性切除。4例患者（8%）因呈现突出边缘或残留边缘模式而切缘阳性。结论：ICG荧光成像可与其他常规术中成像技术结合，以优化术中分期。边缘荧光被证明是评估手术切缘的有效指标：通过切除整个荧光区域，可实现肿瘤阴性切除（R0）。
肿瘤(癌症)患者之家