Abstract
Background: Currently, indocyanine green (ICG) fluorescence imaging enables radical surgical resection in hepatoblastoma (HB) and has beneficial uses; however, its usage in pediatric patients is still limited.Methods: From 2015 to 2019, 17 hepatoblastoma patients underwent 22 fluorescence-guided surgery using ICG. ICG (0.3 mg/kg) was intravenously injected 24–48 h before the operation. With ICG/NIR camera, intraoperative identification of biological structures and demarcation of mass were conducted.Results: ICG fluorescence-guided surgery was performed for hepatoblastoma in 22 cases: 16, 1, and 2 cases underwent anatomic resection, partial hepatectomy, and liver transplantation, respectively. Six patients accompanied lung metastasis at the time of surgery, and two patients underwent lung surgery using ICG. The median interval from ICG injection to surgery was 38.3 h (range, 20.5–50.3 h). The median tumor size was 36.5 mm (range, 2–132 mm). According to the pathologic finding, the median safety margin was secured for 6 mm (range, 0–11 mm) and there was no residual finding at the liver at the follow-up computed tomography (CT).Conclusions: ICG fluorescence imaging in children with HB was feasible and safe for tumor demarcation and enhancing the accuracy of radical tumor resection.
Highlights
Chemotherapy has been used effectively to treat hepatoblastoma (HB), but complete liver resection is the gold standard treatment for this cancer
We retrospectively reviewed all children who underwent HB surgical resection assisted by indocyanine green (ICG) fluorescence imaging between January 2015 and October 2019 at Asan Medical Center, Seoul, Korea
In the time span of the study, 17 pediatric HB patients were subjected to ICG fluorescence imaging in 22 separate surgeries at our hospital
Summary
Chemotherapy has been used effectively to treat hepatoblastoma (HB), but complete liver resection is the gold standard treatment for this cancer. Ishizawa et al first introduced the indocyanine green (ICG) fluorescence technique in 2009 to enhance the accuracy of the liver resection procedure during hepatocellular carcinoma (HCC) surgeries [1]. ICG is extracted from the blood by ICG in Pediatric Hepatoblastoma normal hepatocytes and excreted into the bile. HCC cells do not excrete ICG; it is retained in HCC cells and can be detected using a camera up to several days [3]. ICG imaging technique enabled highly sensitive identification of HCCs by visualizing the disordered biliary excretion of ICG. Indocyanine green (ICG) fluorescence imaging enables radical surgical resection in hepatoblastoma (HB) and has beneficial uses; its usage in pediatric patients is still limited
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