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Determination of surgical margins in laparoscopic parenchyma-sparing hepatectomy of neuroendocrine tumors liver metastases using indocyanine green fluorescence imaging

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Abstract

Background

Neuroendocrine tumors (NETs) are a group of heterogenous tumors originating from neuroendocrine system. Approximately, 40 percent will go through liver metastases, and liver-directed therapy was proved to improve the survival outcome. Parenchyma-sparing hepatectomy is advocated for the resection of NETs liver metastases while the possible relatively low negative margin rate is concerned. Indocyanine green (ICG) fluorescence imaging provides a real-time navigation on determination of surgical margins in colorectal cancer liver metastases. However, there was no previous study that reported the applications of ICG fluorescence imaging in NETs liver metastases. The present study aimed to evaluate the feasibility and security of using ICG fluorescence imaging to determine surgical margins of NETs liver metastases during operation.

Methods

A retrospective two-arm cohort study was performed on 25 consecutive patients with NETs liver metastases who underwent laparoscopic parenchyma-sparing hepatectomy (LPSH). Patients were divided into two groups according to whether or not the ICG fluorescence imaging was used. Data on sociodemographic characteristics, laboratory parameters, pathology results, and surgical outcomes were collected.

Results

A total of 145 tumors pathologically diagnosed with NETs liver metastases were resected from 25 patients. The pathological results indicated negative margins in all tumors (102/102) in LPSH with ICG fluorescence imaging group. The negative margin rate was significantly higher in LPSH using the ICG fluorescence imaging (100% v.s 88.4%, p = 0.002). Surgical outcomes, including operation time, estimated blood loss, intraoperative transfusion rate, and postoperative morbidity, were comparable between LPSH with and without ICG fluorescence imaging groups.

Conclusion

ICG fluorescence imaging showed the potential to identify tumor boundaries and determine surgical margins. This technique may serve as a valuable intraoperative navigation in patients with NETs liver metastases.

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Acknowledgements

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Author notes

  1. Gaoming Wang and Ying Luo have contributed equally to this work.

Authors and Affiliations

  1. Department of General Surgery, Peking University Third Hospital, Beijing, 100191, China

    Gaoming Wang, Weijun Qi, Chunhui Yuan & Dianrong Xiu

  2. Department of Respiration, Peking University Third Hospital, Beijing, China

    Ying Luo

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  1. Gaoming Wang
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Contributions

All authors had the idea for and designed the study. GW, YL, CY, WQ, and DX contributed to the literature search. GW, YL, WQ, and CY contributed to data collection. GW, YL, CY, and DX contributed to data analysis and interpretations. GW and YL contributed to the figures and tables. GW and YL contributed to writing of the manuscript. All authors revised the final manuscript. All authors approved the final version of the article, including the authorship list.

Corresponding author

Correspondence to Dianrong Xiu.

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Disclosures

Gaoming Wang, Ying Luo, Weijun Qi, Chunhui Yuan, and Dianrong Xiu have no conflicts of interest or financial ties to disclose.

Ethical approval

The study was conducted in accordance with the Declaration of Helsinki and the Harmonized Tripartite Guideline for Good Clinical Practice from the International Conference on Harmonization. The study was approved by the institutional review board of Peking University Third Hospital (M2021257).

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Wang, G., Luo, Y., Qi, W. et al. Determination of surgical margins in laparoscopic parenchyma-sparing hepatectomy of neuroendocrine tumors liver metastases using indocyanine green fluorescence imaging. Surg Endosc 36, 4408–4416 (2022). https://doi.org/10.1007/s00464-021-08791-6

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  • DOI: https://doi.org/10.1007/s00464-021-08791-6

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