ICG-Fluorescence Imaging for Margin Assessment During Minimally Invasive Colorectal Liver Metastasis Resection.

Autor:	Achterberg FB; Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands.; Department of Surgery, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands.; Department of Surgery, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.; Cancer Center Amsterdam, Amsterdam, the Netherlands., Bijlstra OD; Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands.; Department of Surgery, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands.; Department of Surgery, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.; Cancer Center Amsterdam, Amsterdam, the Netherlands., Slooter MD; Department of Surgery, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands., Sibinga Mulder BG; Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands., Boonstra MC; Department of Surgery, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands., Bouwense SA; NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, the Netherlands., Bosscha K; Department of Surgery, Jeroen Bosch Ziekenhuis, Den Bosch, the Netherlands., Coolsen MME; Department of Surgery, Maastricht University Medical Center, Maastricht, the Netherlands., Derksen WJM; Department of Surgery, St. Antonius Hospital, Nieuwegein/Regionaal Academisch Kankercentrum Utrecht, Utrecht, the Netherlands., Gerhards MF; Department of Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands., Gobardhan PD; Department of Surgery, Amphia Ziekenhuis, Breda, the Netherlands., Hagendoorn J; Department of Surgery, University Medical Center Utrecht/Regionaal Academisch Kankercentrum Utrecht, Utrecht, the Netherlands., Lips D; Department of Surgery, Medisch Spectrum Twente, Enschede, the Netherlands., Marsman HA; Department of Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands., Zonderhuis BM; Department of Surgery, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands., Wullaert L; Department of Surgery, Amphia Ziekenhuis, Breda, the Netherlands.; Department of Surgical Oncology, Erasmus Medical Center, Rotterdam, the Netherlands., Putter H; Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, the Netherlands., Burggraaf J; Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands.; Centre for Human Drug Research, Leiden, the Netherlands., Mieog JSD; Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands., Vahrmeijer AL; Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands., Swijnenburg RJ; Department of Surgery, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands.; Department of Surgery, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.; Cancer Center Amsterdam, Amsterdam, the Netherlands.
Jazyk:	angličtina
Zdroj:	JAMA network open [JAMA Netw Open] 2024 Apr 01; Vol. 7 (4), pp. e246548. Date of Electronic Publication: 2024 Apr 01.
DOI:	10.1001/jamanetworkopen.2024.6548
Abstrakt:	Importance: Unintended tumor-positive resection margins occur frequently during minimally invasive surgery for colorectal liver metastases and potentially negatively influence oncologic outcomes. Objective: To assess whether indocyanine green (ICG)-fluorescence-guided surgery is associated with achieving a higher radical resection rate in minimally invasive colorectal liver metastasis surgery and to assess the accuracy of ICG fluorescence for predicting the resection margin status. Design, Setting, and Participants: The MIMIC (Minimally Invasive, Indocyanine-Guided Metastasectomy in Patients With Colorectal Liver Metastases) trial was designed as a prospective single-arm multicenter cohort study in 8 Dutch liver surgery centers. Patients were scheduled to undergo minimally invasive (laparoscopic or robot-assisted) resections of colorectal liver metastases between September 1, 2018, and June 30, 2021. Exposures: All patients received a single intravenous bolus of 10 mg of ICG 24 hours prior to surgery. During surgery, ICG-fluorescence imaging was used as an adjunct to ultrasonography and regular laparoscopy to guide and assess the resection margin in real time. The ICG-fluorescence imaging was performed during and after liver parenchymal transection to enable real-time assessment of the tumor margin. Absence of ICG fluorescence was favorable both during transection and in the tumor bed directly after resection. Main Outcomes and Measures: The primary outcome measure was the radical (R0) resection rate, defined by the percentage of colorectal liver metastases resected with at least a 1 mm distance between the tumor and resection plane. Secondary outcomes were the accuracy of ICG fluorescence in detecting margin-positive (R1; <1 mm margin) resections and the change in surgical management. Results: In total, 225 patients were enrolled, of whom 201 (116 [57.7%] male; median age, 65 [IQR, 57-72] years) with 316 histologically proven colorectal liver metastases were included in the final analysis. The overall R0 resection rate was 92.4%. Re-resection of ICG-fluorescent tissue in the resection cavity was associated with a 5.0% increase in the R0 percentage (from 87.4% to 92.4%; P < .001). The sensitivity and specificity for real-time resection margin assessment were 60% and 90%, respectively (area under the receiver operating characteristic curve, 0.751; 95% CI, 0.668-0.833), with a positive predictive value of 54% and a negative predictive value of 92%. After training and proctoring of the first procedures, participating centers that were new to the technique had a comparable false-positive rate for predicting R1 resections during the first 10 procedures (odds ratio, 1.36; 95% CI, 0.44-4.24). The ICG-fluorescence imaging was associated with changes in intraoperative surgical management in 56 (27.9%) of the patients. Conclusions and Relevance: In this multicenter prospective cohort study, ICG-fluorescence imaging was associated with an increased rate of tumor margin-negative resection and changes in surgical management in more than one-quarter of the patients. The absence of ICG fluorescence during liver parenchymal transection predicted an R0 resection with 92% accuracy. These results suggest that use of ICG fluorescence may provide real-time feedback of the tumor margin and a higher rate of complete oncologic resection.
Databáze:	MEDLINE
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