Intraoperative indocyanine green clearance in liver surgery: a useful tool to promote parenchymal preservation?
Carolina González-AbósFabio AusaniaPublished in: Revista espanola de enfermedades digestivas (2023)
A 66-year-old woman was diagnosed with sigmoid carcinoma with bilobar unresectable liver metastases. Primary tumor resection was performed. Neoadjuvant chemotherapy was administered to downstage liver disease. Following FOLFOX/panitumumab (4 cycles), disease progression was observed within the liver. Therefore, chemotherapy regimen was switched to FOLFIRI/cetuximab (12 cycles). At restaging, 7 out of 10 metastases showed complete radiologic response and 3 showed disease progression. Selective internal radiation therapy (SIRT) with Yttrium-90 was performed on these 3 metastases with very good local radiologic response. Surgical resection with curative intent was attempted. ICG was administered 72 hours before surgery to help localization of liver metastases. Intraoperatively, very poor ICG clearance was demonstrated and therefore parenchyma-sparing resections were performed (segment II, III, IV and VII). At final histology, major pathologic response was observed with steatosis of the liver parenchyma. Postoperative course was uneventful and adjuvant capecitabine was administered (8 cycles). No recurrence was demonstrated at 38 months follow-up. However, eighteen months following surgery, she developed impairment of hepatic function and portal hypertension. Conclusion: Preoperative ICG administration could be helpful to intraoperatively detect patients that can develop late post hepatectomy impairment of hepatic function, especially following SIRT2 (REF2), and promote parenchymal preservation.
Keyphrases
- liver metastases
- locally advanced
- neoadjuvant chemotherapy
- metastatic colorectal cancer
- radiation therapy
- rectal cancer
- minimally invasive
- coronary artery bypass
- fluorescence imaging
- squamous cell carcinoma
- patients undergoing
- phase ii study
- end stage renal disease
- surgical site infection
- blood pressure
- oxidative stress
- early stage
- ejection fraction
- sentinel lymph node
- prognostic factors
- robot assisted
- randomized controlled trial
- lymph node
- ischemia reperfusion injury
- peritoneal dialysis
- percutaneous coronary intervention
- insulin resistance
- chronic kidney disease
- skeletal muscle
- photodynamic therapy
- type diabetes
- metabolic syndrome
- metastatic breast cancer
- adipose tissue