Abstract
BackgroundRadiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) is already fully established worldwide. Needle tract implantation and peritoneal seeding occasionally occur by RFA, and the prognosis of these cases is thought to be poor. In this study, intraoperative real-time near-infrared fluorescence (NIRF) system by indocyanine green (ICG) incidentally detected both needle tract implantation and peritoneal seeding. As the utility of this system for identification of implanted and disseminated lesions after RFA for HCC has not been widely reported, we report a case of successful detection by real-time ICG-NIRF imaging and subsequent resection.Case presentationA 76-year-old man originally underwent medial sectionectomy for HCC in 2009. When repeated intrahepatic recurrence occurred, he underwent RFA and transcatheter arterial chemoembolization (TACE) for recurrent HCC twice at segment III and once at segment IV. In 2013, the second hepatectomy for recurrent HCC at segment VIII was performed. In 2016, he had recurrent HCC at segment III around a previous RFA and TACE scar; therefore, left lateral sectionectomy was planned. ICG-NIRF system was used to observe a main intrahepatic metastasis at segment III and to search for other tumors in the remnant liver. Although there was no signal on the surface of the remnant liver, tiny signals were observed in the abdominal wall and greater omentum. These tumors were on the needle tract of the previous RFA; both lesions, therefore, were resected. These tumors were pathologically proven to be HCC metastases. The patient has had no recurrence 14 months after the last hepatectomy.ConclusionsICG-NIRF system might be helpful in the detection of not only intrahepatic lesions but also needle tract implantations or peritoneal seeding. RFA should be avoided in patients with high risk of needle tract implantation and peritoneal seeding.
Highlights
Radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) is already fully established worldwide
indocyanine green (ICG)-near-infrared fluorescence (NIRF) system might be helpful in the detection of intrahepatic lesions and needle tract implantations or peritoneal seeding
RFA should be avoided in patients with high risk of needle tract implantation and peritoneal seeding
Summary
The current case study shows indication that ICG-NIRF system is helpful in the detection of needle tract implantations and peritoneal seeding as well as intrahepatic lesions. Availability of data and materials Data sharing is applicable to this article. Authors’ contributions: MN, SH, and MU contributed in the study conception and design. MN, SH, MU, AM, and NS were involved in the acquisition of data. MN, SH, MU, AM, and NS analyzed and interpreted the data. MN, SH, and MU drafted the manuscript. MK, SH, KO, MM, YK, and HY contributed in the critical revision. All authors read and approved the final manuscript. Ethics approval and consent to participate Not applicable. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations
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