Okker D Bijlstra, Tom H Dijkhuis, Friso B Achterberg, Alexander Broersen, Jouke Dijkstra, Mats I Warmerdam, Rutger B Henrar, Jacobus Burggraaf, A Stijn L P Crobach, Rutger-Jan Swijnenburg, Peter J K Kuppen, Alexander L Vahrmeijer, J Sven D Mieog
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引用次数: 0
Abstract
Background: Near-infrared fluorescence imaging using intravenously administered indocyanine green (ICG) improves colorectal liver metastases (CRLM) surgery by enhancing lesion detection and real-time tumor margin assessment. However, ICG accumulates in hepatocytes around CRLM with high variance between patients. This study evaluates the effects of tumor and patient characteristics on ICG accumulation using a standardized imaging and analysis workflow.
Methods: This single-center study included patients with CRLM who received 10 mg of ICG intravenously 24 h before surgery. Resected lesions were sliced in 5-10-mm-thick sections and immediately imaged for standardized fluorescence analysis. Fluorescence parameters were compared based on chemotherapy treatment, tumor response, tumor size and superficiality, and degree of steatosis. Associations between the patient and tumor characteristics and fluorescence parameters were determined while correcting for confounders.
Results: Thirty-two lesions from 32 patients were analyzed. Lesions from chemotherapy-pretreated patients exhibited a lower mean signal fluorescence intensity (MSFI, 0.23 vs. 0.65 a.u.; p = 0.002) and signal-to-background ratio (SBR, 2.28 vs. 6.08; p < 0.001) than lesions from patients without pretreatment. Tumor size correlated positively with MSFI (p = 0.003), SBR (p = 0.02), and maximum intensity (p < 0.001). After correcting for the other characteristics, chemotherapy showed statistically significant association with the fluorescence parameters. The tumor superficiality, degree of steatosis, and response to chemotherapy had no statistically significant associations with the fluorescence parameters.
Conclusion: Neoadjuvant chemotherapy significantly lowers ICG accumulation around CRLM resulting in suboptimal contrast. To optimize fluorescence-guided surgery protocols for chemotherapy-pretreated patients, future research should focus on adjusting ICG dose and timing and exploring specific fluorescence tumor-targeting imaging agents.
背景：静脉注射吲哚菁绿（ICG）的近红外荧光成像通过增强病变检测和实时肿瘤边缘评估来改善结直肠癌肝转移（CRLM）手术。然而，ICG在CRLM周围的肝细胞中积累，且患者之间差异很大。本研究使用标准化的成像和分析工作流程评估肿瘤和患者特征对ICG积累的影响。方法：这项单中心研究纳入了术前24小时静脉注射10 mg ICG的CRLM患者。将切除的病变切片成5-10毫米厚的切片，并立即成像进行标准化荧光分析。荧光参数根据化疗、肿瘤反应、肿瘤大小和表面、脂肪变性程度进行比较。在校正混杂因素的同时，确定患者与肿瘤特征和荧光参数之间的关联。结果：对32例患者的32个病灶进行了分析。化疗前患者的病变表现出较低的平均信号荧光强度（MSFI, 0.23 vs. 0.65 a.u; p = 0.002）和信号背景比（SBR, 2.28 vs. 6.08; p）。结论：新辅助化疗显著降低CRLM周围ICG积累，导致对比不理想。为了优化化疗前患者的荧光引导手术方案，未来的研究应侧重于调整ICG剂量和时间，并探索特异性荧光肿瘤靶向显像剂。
期刊介绍：
Uniquely positioned at the interface between various medical and surgical disciplines, Surgical Endoscopy serves as a focal point for the international surgical community to exchange information on practice, theory, and research.
Topics covered in the journal include:
-Surgical aspects of:
Interventional endoscopy,
Ultrasound,
Other techniques in the fields of gastroenterology, obstetrics, gynecology, and urology,
-Gastroenterologic surgery
-Thoracic surgery
-Traumatic surgery
-Orthopedic surgery
-Pediatric surgery
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