Exploratory study for the application of photodynamic diagnosis to biliary pancreatic surgery

Abstract

Introduction: Photodynamic diagnosis (PDD) is one of the candidates for navigation surgery in HPB malignancies. The purpose of this presentation is to show our exploratory study for the application of 5-ALA-PDD and ICG-PDD to biliary pancreatic surgery. Method: Two studies were enrolled. Result: Study 1: 5-ALA-PDD on an animal model. The purpose of this model study was to determine if 5-ALA-PDD could detect lesions in murine models of biliary-pancreatic cancers. Methods: A murine peritoneal disseminated nodule model was established by intraperitoneal injection of TFK-1 and PK-1 cells. Results: In the murine model of peritoneal dissemination, micro-disseminated nodules (< 1 mm) that could not be detected under white light were clearly visible using 5-ALA-PDD. Study 2: ICG-PDD. A) ICG-PDD on the hepatoduodenal ligament to the para-aortic area. The purpose of this study was to investigate whether ICG-PDD could demonstrate LF/lymph nodes (LN) of biliary or pancreatic tumor. Methods: 43 patients with HPB malignancies were enrolled in this study. After 5 mg/ml of ICG (0.5 ml) was injected into the Calot's triangle, LF/LN were observed. Results: LF/LN were detected in 29 out of 43 patients, on the hepatoduodenal ligaments or in the para-aortic area. Fluorescent signals were recorded in the LN along the bile duct and the posterior surface of the head of the pancreas. We also detected PAN fluorescent signals on the right side of the aorta, around the left renal vein. B) PDD for pancreatic neuroendocrine tumor (pNET). Methods: Two cases of pNET (pancreatic body and head) were evaluated. After laparotomy, 5 mg/ml of ICG (0.5 ml) was injected; LF and LN were then observed. Results: ICG accumulated in LN 8a on the pancreatic body pNET, and LN14d were also detected on the pancreatic head tumor. Conclusion: In conclusion, ICG-PDD can be applicable for navigation surgery to identify areas of lymphadenectomy in HPB malignancies.