Usefulness and limitation of indocyanine green fluorescence for detection of peritoneal recurrence after hepatectomy for hepatocellular carcinoma: a case report

Abstract

Background Peritoneal recurrence of hepatocellular carcinoma (HCC) after hepatectomy occurs rarely, accounting for less than 1% of all recurrences. Reported causes of such dissemination include a history of rupture of the original HCC, needle biopsy or puncture treatment, and surgical procedures. There is no consensus on the optimal treatment strategy for peritoneal dissemination. There have been few reports on assisting resection of peritoneal dissemination by using indocyanine green (ICG) fluorescence. Case presentation A 57-year-old man underwent posterior sectionectomy for HCC. Six months later, computed tomography revealed multiple nodules suspected of indicating peritoneal dissemination. Various preoperative imaging studies demonstrated only four nodules, the doubling time of the tumors being rapid at 22 days. The nodules were therefore resected. ICG (0.5 mg/kg) was injected intravenously 2 days before the procedure, enabling identification of the nodules by their brightness in the operative field under near-infrared lighting. A total of eight lesions were detected during the procedure and resected, some of which had not been identified by preoperative imaging studies. We diagnosed peritoneal dissemination of HCC based on the pathological findings and their similarity to those of the original HCC. We concluded that the recurrences were likely attributable to exposure of the tumor to the serosa at the time of the original operation. Conclusions Although ICG fluorescence is useful for identifying peritoneal dissemination of HCC, attention should be paid to the difficulty in detecting deep lesions and occurrence of false positives.

Favorable control of hepatocellular carcinoma with peritoneal dissemination by surgical resection using indocyanine green fluorescence imaging: a case report and review of the literature

“…To assess the efficacy of ICG fluorescence for resection of peritoneal dissemination in patients with HCC, we conducted a literature search using the PubMed database and found seven cases of surgical resection for peritoneal dissemination of HCC using ICG fluorescence imaging, including our case [ 4 – 6 , 10 , 14 ] (Table 1 ). There were two cases of rupture of primary HCC (cases 2 and 7), and TAE was performed in all cases.…”

“…Indocyanine green (ICG), which fluoresces green when irradiated with near-infrared light, has been used not only for assessment of liver function but also for surgical navigation. Recent reports have shown that the ICG fluorescence pattern is useful for distinguishing between tumor and normal tissues for both primary and extrahepatic lesions of HCC [ 4 – 6 ]. It has also been reported that ICG accumulates better in highly differentiated than moderately or poorly differentiated HCC [ 7 ].…”

Essential updates 2020/2021: Current topics of simulation and navigation in hepatectomy

“…38 Kubo et al 39 In tumor detection, ICG is useful to identify not only intrahepatic tumors 43 but also extrahepatic metastatic tumors such as those in the adrenal gland 44 or abdominal wall. 45 Tumor detection with ICG contributes to the safe achievement of surgical margins during liver resection. 46 Purich et al 47 performed a systematic review and metaanalysis of the diagnostic test accuracy of ICG.…”

Carbon Dots: From Synthesis to Unraveling the Fluorescence Mechanism

“…[ 23 ] Subsequently, the low QY and the complex synthetic procedure of CDs restricted the widespread use of CDs in fluorescence‐based imaging techniques. [ 25–28 ] Ever since, the field has progressed momentously as more and more synthetic protocols are now being reported, all with improved QYs. The recent reports demonstrated that CDs can be produced by a variety of synthetic processes, including hydrothermal treatment, laser ablation, pyrolysis, and microwave techniques.…”