Is there a role for near-infrared technology in laparoscopic resection of pancreatic neuroendocrine tumors? Results of the COLPAN “colour-and-resect the pancreas” study

Abstract

Background

The intraoperative identification of pancreatic neuroendocrine tumors (PanNETs) is of utmost importance to drive their laparoscopic resection. Near-infrared (NIR) surgery has emerged as a new technique for localizing tumors or neoplastic tissue. This study aimed to explore the results of the application of NIR in the laparoscopic resection of PanNETs.

Methods

Per protocol we enrolled ten subjects undergoing laparoscopic pancreatic surgery for PanNET from March 2016 to October 2016. During surgery, the patients were injected with indocyanine green dye (ICG, 25 mg given in 5 boli of 5 mg each). The switch-activation of NIR was performed to identify PanNETs. An ex-post analysis of the images was realized using ImageJ Software® to calculate the fluorescence signal.

Results

NIR imaging identified all ten PanNETs. Nine (90%) laparoscopic distal pancreatectomy with splenectomy and one (10%) laparoscopic enucleation were performed. The mean maximum tumor dimension was 2.4 cm (range 1–4 cm). Eight non-functioning PanNETs (80%) and two insulinomas (20%) were found at the final pathology. Nine out of ten (90%) PanNETs were detected after the second ICG bolus. The mean latency time was 80 s and the mean visibility time was 220 s. The peak of tumor visualization was reached 20 min after the last bolus. This finding was confirmed by the ex-post analysis of the fluorescence signal (mean signal-to-background ratio of 7.7, p = 0.001). NIR identified two additional lesions, which turned out to be normal lymph nodes at final pathology. A fluorescent signal was identified at the bed of the enucleation, and thus, a further exeresis was performed and final pathology revealed that is was residual neoplastic tissue.

Conclusions

This explorative study shows that NIR with ICG can have a role in laparoscopic pancreatic resection of PanNETs. Further studies are needed to assess the proper setting and role of this new and promising technology.

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Funding

This project won a Research Grant of the European Association of Endoscopic Surgery (EAES), Bucharest, Romania, June 2015.

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Correspondence to Salvatore Paiella.

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Disclosures

Drs. Salvatore Paiella, Matteo De Pastena, Luca Landoni, Alessandro Esposito, Luca Casetti, Marco Miotto, Marco Ramera, Roberto Salvia, Mirko D’Onofrio, Giovanni Marchegiani, Claudio Bassi, Mses Erica Secchettin, Deborah Bonamini, and Gessica Manzini have no conflicts of interest or financial ties to disclose.

Additional information

Salvatore Paiella and Matteo De Pastena share the first authorship.

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Paiella, S., De Pastena, M., Landoni, L. et al. Is there a role for near-infrared technology in laparoscopic resection of pancreatic neuroendocrine tumors? Results of the COLPAN “colour-and-resect the pancreas” study. Surg Endosc 31, 4478–4484 (2017). https://doi.org/10.1007/s00464-017-5501-5

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Keywords

  • Laparoscopic pancreatic surgery
  • Pancreatic neuroendocrine tumors
  • Near-infrared (NIR)
  • Fluorescence-guided surgery
  • Indocyanine green