Abstract
In the past decade, navigation surgery using fluorescent indocyanine green (ICG) dye for hepatoblastoma (HB) has been developed for the resection of primary or metastatic tumors. Since HB cells can take up ICG but cannot excrete it to the bile duct, ICG remains in the HB cells, which can be used for navigation by fluorescent activation. The complete resection of the primary tumor as well as metastatic tumors, along with appropriate neoadjuvant and adjuvant chemotherapy, is essential for cure. ICG fluorescence can detect microscopic residual lesions in the primary lesion and identify micro-metastases in the lung or other lesions; consequently, ICG navigation surgery may improve outcomes for patients with HB. The basic technique and recent advances in ICG navigation for HB surgery are reviewed.
Highlights
Hepatoblastoma (HB) is the most common pediatric malignant liver tumor, and is usually diagnosed in children under three years of age
In patients with intermediate-risk tumors, which are unresectable at diagnosis due to PRETEXT IV and/or positive annotation factors, such as portal vein invasion, hepatic vein invasion, and tumor rupture, the outcomes of those whose tumors become resectable with neoadjuvant chemotherapy are favorable [2,3]
In patients with high-risk tumors, who usually have lung metastases, those whose metastases are diminished by chemotherapy or completely resected by thoracotomy have favorable outcomes [4]
Summary
Hepatoblastoma (HB) is the most common pediatric malignant liver tumor, and is usually diagnosed in children under three years of age. Since the outcomes for patients with HB depend on the complete resection of the tumor, patients with low-risk HBs, which are usually resectable at diagnosis, have more than 85% survival. In patients with high-risk tumors, who usually have lung metastases, those whose metastases are diminished by chemotherapy or completely resected by thoracotomy have favorable outcomes [4]. The complete resection of the primary liver tumor and the diminishment of metastases by chemotherapy and/or thoracotomy may be essential for the cure of patients with HB. More precise resection using navigation for the existence of tumor cells might be effective for improving outcomes for patients with HB. ICG is taken up by malignant liver tumor cells, such as hepatocellular carcinoma, hepatoblastoma, and others. In this review, which focuses on ICG fluorescence-guided navigation surgery for HB, we discuss the development, underlying ICG uptake mechanism, clinical applications, and future potential of this technology
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