Combined Use of Three-Dimensional Construction and Indocyanine Green-Fluorescent Imaging for Resection of Multiple Lung Metastases in Hepatoblastoma

Abstract

It is essential to accurately and safely resect all tumors during surgery for multiple lung metastases. Here, we report a case of hepatoblastoma (HB) with multiple pulmonary nodules that ultimately underwent complete resection using combined three-dimensional image reconstruction and indocyanine green (ICG) fluorescence guidance. A 1-year-old boy was diagnosed with HB and multiple lung metastases. After intensive chemotherapy, complete resection with subsegmentectomy (S5 + 6) and partial resection (S3, S8) were performed. More than 100 pulmonary nodules, which remained visible on computed tomography (CT) despite additional postoperative chemotherapy, were subjected to pulmonary resection. We used the SYNAPSE VINCENT software (Fujifilm Medical, Tokyo, Japan) to obtain three-dimensional images of the nodules. We numbered each nodule, and 33 lesions of the right lung were resected by multiple wedge resections through a right thoracotomy, with the aid of palpation and ICG fluorescence guidance. One month after the right metastasectomy, resection of 64 lesions in the left lung was performed via left thoracotomy. Postoperative CT showed complete clearance of the lung lesions, and the patient remained disease-free for 15 months after the treatment. This case study confirms that the combination of three-dimensional localization and ICG fluorescence guidance allows for accurate and safe resection of nearly 100 lung metastases.

Indocyanine green navigation in minimally invasive resection of multiple metachronous pulmonary metastases of hepatoblastoma

“…5 ICG has been previously used in the resection of pulmonary HB metastases by an open approach. 3,4 Nevertheless, ICG-guided thoracoscopic resection of multiple metachronous pulmonary metastases of HB has not been reported to date. From our point of view, it has numerous advantages over the open approach, mainly due to the lower surgical impact compared to thoracotomy, with smaller incisions, less postoperative pain, and therefore shorter length of hospital stay.…”

“…ICG has been previously used in the resection of pulmonary HB metastases by an open approach 3,4 . Nevertheless, ICG‐guided thoracoscopic resection of multiple metachronous pulmonary metastases of HB has not been reported to date.…”

“…Indocyanine green (ICG) is a fluorescent dye that is well absorbed by hepatocyte‐derived neoplastic cells and is excited by infrared radiation at 760 nm, emitting fluorescence at 830 nm. 2 Based on these unique characteristics, it has been applied to detect both liver and metastatic site lesions in HB, 3 , 4 although its utility in minimally invasive surgery has been rarely reported. We present the utility of ICG navigation in thoracoscopic resection of multiple metachronous pulmonary metastasis of HB.…”

Thoracoscopic Resection of Lung Nodules following CT-Guided Labeling in Children and Adolescents with Solid Tumors

“…Preoperative labeling combined with minimally invasive resection of metastases has been developed during recent years to meet these challenges. Different techniques pursuing this approach have been described, some of them also in children [ 7 , 8 , 9 , 10 , 11 , 12 , 13 , 21 , 22 , 23 ]. These methods include labeling with Indocyanine Green (ICG) or other fluorescending agents, radionuclear labeling, or the use of hook wires.…”