Intraoperative Near-Infrared Imaging with Second Window Indocyanine Green for Pancreatic Adenocarcinoma

Timing of administration of indocyanine green for fluorescence-guided surgery in pancreatic cancer: response to Shirakawa et al

“…Near-infrared imaging of the primary tumour using ICG has also shown varying results due to timing of administration. Newton and colleagues published two studies (n = 4 and n = 12) demonstrating that after preoperative (24 h) ICG administration, TBRs of 4.6-4.9 could be achieved in the primary tumour site [4,5]. However, a study by Hutteman et al failed to generate meaningful TBRs with intraoperative ICG administration due to physiological uptake in the normal pancreas (likely related to its high blood supply compared to the tumour mass).…”

The development of fluorescence guided surgery for pancreatic cancer: from bench to clinic

“…Hutteman et al administered 5 or 10mg of ICG to patients undergoing pancreaticoduodenectomy and found that in 7/8 there was no useful dye uptake or signal localization at the tumor[114]. Larger doses of ICG at 5mg/kg have been administered to patients 24 hours prior to surgical resection of their pancreatic cancer and this shows some potential; 4/4 patients had a fluorescent signal at the tumor with a mean TBR of 4.9[115]. ICG fluorescence for pancreatic surgeries has also been applied to visualize reconstructed biliary structures, check perfusion of bowel anastomoses or identify occult hepatic metastases by negative staining[116–118].…”