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Fluorescence-Guided Surgery in the Combined Treatment of Peritoneal Carcinomatosis from Colorectal Cancer: Preliminary Results and Considerations

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Abstract

Background

Indocyanine green (ICG) is a near-infrared fluorescent contrast agent, which preferentially accumulates in cancer tissue. The aim of our study was to investigate the role of fluorescence imaging (FI) with ICG (ICG-FI) for detecting peritoneal carcinomatosis (PC) from colorectal cancer (CRC).

Methods

Four CRC patients with PC scheduled for cytoreductive surgery + hyperthermic intraperitoneal chemotherapy were enrolled in this prospective study. At a median time of 50 min after 0.25 mg/kg ICG injected intravenously, intraoperative ICG-FI using Fluobeam® was performed in vivo and ex vivo on all specimens. The Peritoneal Cancer Index was used to estimate the likelihood of complete cytoreduction.

Results

No severe complications were recorded. ICG-FI took a median of 20 min (range 10–30, IQR 15–25). Sixty-nine nodules were harvested. Fifty-two nodules had been diagnosed preoperatively by conventional imaging (n = 30; 43%) or intraoperatively by visual inspection/palpation (n = 22; 32%). With ICG-FI, 47 (90%) nodules were hyperfluorescent, and five hypofluorescent. Intraoperative ICG-FI identified 17 additional hyperfluorescent nodules. On histopathology, 16 were metastatic nodules. Sensitivity increased from 76.9%, with the conventional diagnostic procedures, to 96.9% with ICG-FI. The positive predictive value of ICG-FI was 98.4%, and test accuracy was 95.6%. Diagnostic performance of ICG-FI was significantly better than preoperative (p = 0.027) and intraoperative conventional procedures (p = 0.042). The median PCI score increased from 7 to 10 after ICG-FI (p < 0.001).

Conclusions

Our results suggest that intraoperative ICG-FI can improve outcomes in patients undergoing CS for PC from CRC. Further studies are needed to determine the role of ICG-FI in this patient population.

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Author information

Authors and Affiliations

  1. Division of Surgical Oncology, Department of Surgical Sciences, University of Campania ‘Luigi Vanvitelli’ - School of Medicine, c/o II Policlinico, Edificio 17, Via Pansini, 5, 80131, Naples, Italy

    Eva Lieto, Annamaria Auricchio, Francesca Cardella, Andrea Mabilia, Nicoletta Basile, Paolo Castellano & Gennaro Galizia

  2. Division of Medical Oncology - “F. Magrassi” Department of Clinical and Experimental Medicine, University of Campania ‘Luigi Vanvitelli’ - School of Medicine, Naples, Italy

    Michele Orditura

Authors
  1. Eva Lieto
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  2. Annamaria Auricchio
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  3. Francesca Cardella
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  4. Andrea Mabilia
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  5. Nicoletta Basile
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  6. Paolo Castellano
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  7. Michele Orditura
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  8. Gennaro Galizia
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Corresponding author

Correspondence to Gennaro Galizia.

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Supplemental Figure 1.

Receiver operating characteristic curves of ICG-FI guided surgery, and pre- and intraoperative conventional technology (AUC= area under the curve) (TIFF 252 kb)

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Lieto, E., Auricchio, A., Cardella, F. et al. Fluorescence-Guided Surgery in the Combined Treatment of Peritoneal Carcinomatosis from Colorectal Cancer: Preliminary Results and Considerations. World J Surg 42, 1154–1160 (2018). https://doi.org/10.1007/s00268-017-4237-7

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  • DOI: https://doi.org/10.1007/s00268-017-4237-7

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