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Resection of Hepatic Lesions Perfused by the Cholecystic Vein Using Indocyanine Green Navigation in Patients with cT2 Gallbladder Cancer

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Abstract

Background

Various approaches to hepatectomy have been proposed for cT2 gallbladder cancers (GBC), but the optimal management strategy remains unclear. The aim of this study is to assess the effectiveness of using an indocyanine green (ICG)-based intraoperative navigation system during hepatic resection for cT2 GBC.

Methods

From September 2007 to December 2017, 24 consecutive patients diagnosed with cT2 GBC underwent hepatic resection using ICG navigation. After cannulation of the cholecystic artery, ICG diluted with dissolution liquid was injected and ICG fluorescence illumination was visualized with the HyperEye Medical System. And additional histopathological examination was performed on the most recent 15 of the 24 patients for detection of microscopic liver metastasis.

Results

For all patients, the disease-free survival rate was 59.1% at 5 years and overall survival rate was 86.2% at 5 years. Microscopic liver metastasis was detected in the resected liver in 3 (20%) of 15 patients, whose site of liver was S6, S5, and S5, respectively. The weight of the liver resected using ICG navigation was significantly smaller than that of S4a/S5 segmentectomy (P < 0.0001).

Conclusion

Resected hepatic lesion using ICG imaging was possible to perform hepatectomy including liver micro-metastasis without excess or deficiency. This procedure might be novel intraoperative imaging method to provide valuable information on the optimal surgical approach to cT2 GBC.

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Authors and Affiliations

  1. Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi Hachioji, Tokyo, 193-0998, Japan

    Naokazu Chiba, Shigeto Ochiai, Kei Yokozuka, Takahiro Gunji, Masaaki Okihara, Toru Sano, Koichi Tomita, Rina Tsutsui, Go Oshima, Kiminori Takano & Shigeyuki Kawachi

  2. Department of Surgery, Tama Kyuryo Hospital, 1491 Shimooyamada Machida, Tokyo, 194-0297, Japan

    Motohide Shimazu

  3. Department of Surgery, Keio University School of Medicine, 35 Shinanomachi Shinjuku, Tokyo, 160-0016, Japan

    Yuta Abe

  4. Department of Pathology, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi Hachioji, Tokyo, 193-0998, Japan

    Hiroshi Hirano

Authors
  1. Naokazu Chiba
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  2. Motohide Shimazu
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  3. Shigeto Ochiai
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  4. Kei Yokozuka
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  5. Takahiro Gunji
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  6. Masaaki Okihara
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  7. Toru Sano
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  8. Koichi Tomita
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  9. Rina Tsutsui
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  10. Go Oshima
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  11. Kiminori Takano
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  12. Yuta Abe
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  13. Hiroshi Hirano
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  14. Shigeyuki Kawachi
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Contributions

N Chiba, M Shimazu, and S Kawachi were involved in study design. N Chiba was involved in acquisition of data. Operation procedures were performed by all authors. N Chiba helped in analysis and interpretation. N Chiba contributed to drafting manuscript. N Chiba and S Kawachi helped in revision.

Corresponding author

Correspondence to Naokazu Chiba.

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Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

This research has been approved by Tokyo Medical University Hachioji Medical Center Ethics Committee.

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Chiba, N., Shimazu, M., Ochiai, S. et al. Resection of Hepatic Lesions Perfused by the Cholecystic Vein Using Indocyanine Green Navigation in Patients with cT2 Gallbladder Cancer. World J Surg 43, 608–614 (2019). https://doi.org/10.1007/s00268-018-4810-8

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  • DOI: https://doi.org/10.1007/s00268-018-4810-8

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