Staging laparoscopy combined with laparoscopic ultrasound and near-infrared fluorescence imaging to detect occult pancreatic metastases

Abstract

Background: Up to 38% of patients with pancreatic cancer undergoing surgery with curative intent turn out to have incurable disease. Staging laparoscopy (SL) is therefore being advocated in selected patients. This study aims to determine if the yield of SL can be amplified by adding laparoscopic ultrasound (LUS) and fluorescence imaging (LFI). Methods: All patients planned to undergo resection of pancreatic or periampullary cancer were included prospectively. Patients received an intravenous infusion of 10 mg indocyanine green (ICG) 1 or 2 days before surgery to allow LFI of potential liver metastases. Suspect lesions were analyzed via biopsy or resection. Results: A total of 21 patients is currently included. Suspect lesions were identified in 3 patients: liver metastases (identified by inspection, LFI and LUS), peritoneal metastases (inspection) and a lesion that appeared to be benign afterwards (LUS). Quality of LFI was good in 8/13 (62%) patients dosed 1 day and in 6/7 (86%) patients dosed 2 days prior to surgery. Eighteen patients had no signs of irresectability during SL; the primary tumor was resected in 16 patients. Two out of 8 patients with a follow-up >6 months after resection developed liver metastases. Conclusion: Despite current preoperative imaging modalities, metastases are still identified during surgery. The current study shows limited added value of LUS and LFI during SL in pancreatic cancer patients. A total of 25 patients will be included and additional follow-up will be available for presentation.