Advertisement

World Journal of Surgery

, Volume 43, Issue 2, pp 608–614 | Cite as

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

  • Naokazu ChibaEmail author
  • Motohide Shimazu
  • Shigeto Ochiai
  • Kei Yokozuka
  • Takahiro Gunji
  • Masaaki Okihara
  • Toru Sano
  • Koichi Tomita
  • Rina Tsutsui
  • Go Oshima
  • Kiminori Takano
  • Yuta Abe
  • Hiroshi Hirano
  • Shigeyuki Kawachi
Original Scientific Report (including Papers Presented at Surgical Conferences)
  • 89 Downloads

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.

Notes

Authors contribution

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.

Compliance with ethical standards

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.

References

  1. 1.
    Chijiiwa K, Tanaka M (1994) Carcinoma of the gallbladder: an appraisal of surgical resection. Surgery 115:751–756Google Scholar
  2. 2.
    Yamaguchi K, Chijiiwa K, Saiki S, Nishihara K, Takashima M, Kawakami K et al (1997) Retrospective analysis of 70 operations for gallbladder carcinoma. Br J Surg 84:200–204CrossRefGoogle Scholar
  3. 3.
    Kai M, Chijiiwa K, Ohuchida J, Nagano M, Hiyoshi M, Kondo K (2007) A curative resection improves the postoperative survival rate even in patients with advanced gallbladder carcinoma. J Gastrointest Surg 11:1025–1032CrossRefGoogle Scholar
  4. 4.
    Sasaki R, Uesugi N, Itabashi H, Fujita T, Takeda Y, Hoshikawa K et al (2005) Clinicopathological study of depth of subserosal invasion in patients with pT2 gallbladder carcinoma. J Surg Oncol 92:83–88CrossRefGoogle Scholar
  5. 5.
    Dong HK, Sung HK, Gi HC, Chang MK, Kyung SK, Jin SC et al (2013) Role of cholecystectomy and lymph node dissection in patients with T2 gallbladder cancer. World J Surg 37:2635–2640.  https://doi.org/10.1007/s00268-013-2187-2 CrossRefGoogle Scholar
  6. 6.
    Sheikh MA, Osman H, Cheek S, Hunter S, Jeyarajah DR (2016) T2 gallbladder cancer—aggressive therapy is warranted. Am Surg 82:519–521Google Scholar
  7. 7.
    Kondo S, Nimura Y, Kamiya J, Nagino M, Kanai M, Uesaka K et al (2002) Mode of tumor spread and surgical strategy in gallbladder carcinoma. Langenbecks Arch Surg 387:222–228CrossRefGoogle Scholar
  8. 8.
    Dip FD, Ishizawa T, Kokudo N, Rosenthal R (2015) Fluorescence imaging for surgeons. Springer, SwitzerlandCrossRefGoogle Scholar
  9. 9.
    Rosenthal EL, Warram JM, de Boer E, Basilion JP, Biel MA, Bogyo M et al (2016) Successful translation of fluorescence navigation during oncologic surgery: a consensus report. J Nucl Med 57(1):144–150CrossRefGoogle Scholar
  10. 10.
    Ishizawa T, Bandai Y, Ijichi M, Kokudo N (2010) Fluorescent cholangiography illuminating the biliary tree during laparoscopic cholecystectomy. Br J Surg 97:1369–1377CrossRefGoogle Scholar
  11. 11.
    van der Vorst JR, Schaafsma BE, Hutteman M, Verbeek FP, Liefers GJ, Hartgrink HH et al (2013) Near-infrared fluorescence-guided resection of colorectal liver metastases. Cancer 119(18):3411–3418CrossRefGoogle Scholar
  12. 12.
    Inoue Y, Arita J, Sakamoto T, Ono Y, Takahashi M, Takahashi Y et al (2015) Anatomical liver resections guided by 3-dimensional parenchymal staining using fusion indocyanine green fluorescence imaging. Ann Surg 262(1):105–111CrossRefGoogle Scholar
  13. 13.
    Toh U, Iwakuma N, Mishima M, Okabe M, Nakagawa S, Akagi Y (2015) Navigation surgery for intraoperative sentinel lymph node detection using Indocyanine green (ICG) fluorescence real-time imaging in breast cancer. Breast Cancer Res Treat 153(2):337–344CrossRefGoogle Scholar
  14. 14.
    Namikawa T, Uemura S, Kondo N, Yamamoto M, Maeda H, Nishimori H et al (2014) Successful preservation of the mesenteric and bowel circulation with treatment for a ruptured superior mesenteric artery aneurysm using the HyperEye Medical System. Am Surg 80(12):E359–E361Google Scholar
  15. 15.
    Japanese Society of Hepato-Biliary-Pancreatic Surgery (2013) General Rules for Clinical and Pathological Studies on Cancer of the Biliary Tract, 6th edn. Kanehara & Co., Ltd., Tokyo (in Japanese) Google Scholar
  16. 16.
    Shirai Y, Yoshida K, Tsukada K, Ohtani T, Muto T (1992) Identification of the regional lymphatic system of the gallbladder by vital staining. Br J Surg 79:659–662CrossRefGoogle Scholar
  17. 17.
    Sumiyoshi K, Nagai E, Chijiiwa K, Nakayama F (1991) Pathology of carcinoma of the gallbladder. World J Surg 15:315–321.  https://doi.org/10.1007/BF01658722 CrossRefGoogle Scholar
  18. 18.
    Kai K, Satoh S, WatanabeT Endo Y (2010) Evaluation of cholecystic venous flow using indocyanine green fluorescence angiography. JHBPS 17:147–151Google Scholar
  19. 19.
    Sugita M, Ryu M, Satake M, Kinoshita T, Konishi M et al (2000) Intrahepatic inflow areas of the drainage vein of the gallbladder: analysis by angio-CT. Surgery 128:417–421CrossRefGoogle Scholar
  20. 20.
    Shirai Y, Tsukada K, Ohtani T, Watanabe H, Hatakeyama K (1995) Hepatic metastases from carcinoma of the gallbladder. Cancer 75:2063–2068CrossRefGoogle Scholar
  21. 21.
    Ogura Y, Tabata M, Kawarada Y, Mizumoto R (1998) Effect of hepatic invasion on the choice of hepatic resection for advanced carcinoma of the gallbladder: histologic analysis of 32 surgical cases. World J Surg 22:262–267.  https://doi.org/10.1007/s002689900380 CrossRefGoogle Scholar
  22. 22.
    Endo I, Shimada H, Takimoto A, Fujii Y, Miura Y, Sugita M et al (2004) Microscopic liver metastasis: prognostic factor for patients with pT2 gallbladder carcinoma. World J Surg 28:692–696.  https://doi.org/10.1007/s00268-004-7289-4 CrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2018

Authors and Affiliations

  • Naokazu Chiba
    • 1
    Email author
  • Motohide Shimazu
    • 2
  • Shigeto Ochiai
    • 1
  • Kei Yokozuka
    • 1
  • Takahiro Gunji
    • 1
  • Masaaki Okihara
    • 1
  • Toru Sano
    • 1
  • Koichi Tomita
    • 1
  • Rina Tsutsui
    • 1
  • Go Oshima
    • 1
  • Kiminori Takano
    • 1
  • Yuta Abe
    • 3
  • Hiroshi Hirano
    • 4
  • Shigeyuki Kawachi
    • 1
  1. 1.Department of Digestive and Transplantation SurgeryTokyo Medical University Hachioji Medical CenterTokyoJapan
  2. 2.Department of SurgeryTama Kyuryo HospitalTokyoJapan
  3. 3.Department of SurgeryKeio University School of MedicineTokyoJapan
  4. 4.Department of PathologyTokyo Medical University Hachioji Medical CenterTokyoJapan

Personalised recommendations