Abstract
Fluorescence-guided surgery with indocyanine green (ICG) for malignant hepatic tumors has been gaining more attention with technical advancements. Since hepatoblastomas (HBs) possess similar features to hepatocellular carcinoma, fluorescence-guided surgery can be used for HBs, as aggressive surgical resection, even for distant metastases of HBs, often contributes positively to R0 (complete) resection and subsequent patient survival. Despite a few caveats, fluorescence-guided surgery allows for the more sensitive identification of lesions that may go undetected by conventional imaging or be invisible macroscopically. This leads to precise resection of distant metastatic tumors as well as primary liver tumors.
Highlights
The real-time identification of cancer tissues is desperately needed among surgeons in the field of oncology
We reported the first application of this system to metastasectomy in an HB patient [33]
When resecting pulmonary metastases or other lesions with no interference from residual fluorescence emitted by the liver or bowels, indocyanine green (ICG) can be given the day before the operation, since there is no concern about background fluorescence
Summary
The real-time identification of cancer tissues is desperately needed among surgeons in the field of oncology. In 2009, Japanese groups developed intraoperative fluorescence cholangiography by focusing on the biliary excretion of ICG [9]. The advent of real-time cancer visualization in hepatobiliary surgery was an incidental product of the intentional application of intraoperative cholangiography, which was originally discovered by Ishizawa et al [10]. Hepatoblastomas (HBs), which are the most common pediatric malignant liver tumors and usually diagnosed under three years of age, presumably possess similar features to adult HCC in terms of the ICG uptake and excretion into the biliary system. In this review focusing on ICG fluorescence-guided surgery for HB, the developments, mechanism underlying the ICG uptake, clinical applications, and our experiences are detailed, and future possibilities are discussed
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