NOVEL APPROACH FOR TUMOR LOCALIZATION MARKING WITH ENOUGH SURGICAL MARGIN FOR LUNG NEOPLASMS BY USING FLUORESCENCE-GUIDED SURGERY

Abstract

SESSION TITLE: Advancing the Decision-Making Process in Lung Cancer SESSION TYPE: Original Investigations PRESENTED ON: 10/22/2019 10:45 AM - 10:45 AM PURPOSE: Recent advances of computer tomography make the increase of early stage lung cancer detection and various methods of tumor localization marking have been reported in minimally invasive surgery. However, precise tumor localization with enough surgical margin has not been well established. We previously developed and reported a novel approach for performing segmentectomy by using an infrared thoracoscopy with transbronchial instillation of indocianine green (ICG) by combining with 3D virtual sublobar resection with enough surgical margin. We applied this method to serve both as tumor localization marking and anatomical partial lung resection with enough surgical margin. The purpose of this study is the feasibility of anatomical partial lung resection by using combination of 3D image analyzer and fluorescence guided surgery. METHODS: From September 2014 to November 2018, 15 cases (9 lung cancers, 7 metastatic lung tumors) were enrolled and attempted anatomical partial resection under the guidance of fluorescence. For each case, several virtual sublobar resections were created by 3D Image Analyzer (Fujifilm Co, Tokyo, Japan) preoperatively. The surgical margin was measured in each simulated sublobar resection and the most appropriate procedure was selected. Surgical resection with matching virtual sublobar resection was performed using infrared thoracoscopy with transbronchial indocyanine green instillation. Ten ml of the 10-fold saline-autologous blood-diluted ICG was instilled into each associated subsubsegmental bronchus under general anesthesia. At the beginning of the surgery, a near-infrared (NIR) thoracoscope (PINPOINT, Stryker, MI, USA) was used to visualize the intersegmental lines and planes. The visceral pleura was marked using electric cautery along the border of ICG fluorescence. During operation, the lung was deeply catted according to the border by electric cautery and staplers. The border clarity of ICG fluorescence was evaluated and the distance from the tumor to the surgical margin was compared to simulation in order to investigate success of ICG injection. RESULTS: The mean diameter of the tumor was 15.5+/-7.4mm. The success rate of transbronchial ICG injections was 100% (15/15), because a targeted tumor was involved in the resected specimen in all cases. The shortest distances to the surgical margin by simulation and by actual measurement were 15.1+/-12.2 mm and 14.1+/-6.5mm, respectively (p=0.6474). CONCLUSIONS: ICG-guided anatomical partial resection by transbronchial ICG instillation based on the preoperative 3D image analysis is feasible and obtain enough surgical margin. CLINICAL IMPLICATIONS: This novel approach is fulfill not only precise tumor localization marking but also enough tumor resection margin for nonpalpable small nodule. DISCLOSURES: no disclosure on file for Hidehisa Hoshino; No relevant relationships by Eitetsu Koh, source=Web Response no disclosure on file for Hodaka Oheda; No relevant relationships by YASUO SEKINE, source=Web Response