Abstract
Abstract
Background
Hepatic arterial infusion pump (HAIP) treatment is a technique used to treat liver localized malignancy with intra-arterial chemotherapy. Methylene blue is generally administered to verify hepatic perfusion and exclude inadvertent extrahepatic perfusion. The use of indocyanine green dye (ICG) combined with near-infrared (NIR) fluorescence imaging during robot-assisted HAIP placement may be an attractive alternative by providing high contrast without blue discoloration of the operative field.
Methods
Data was collected retrospectively from 2 centers in the Netherlands. Intraoperative perfusion of the liver segments and extrahepatic perfusion were assessed using ICG/NIR as well as methylene blue on video imaging and correlated to postoperative 99 m-Tc perfusion scintigraphy.
Results
13 patients underwent robot-assisted surgery for HAIP placement; median length of stay was 4 days, complications occurred in 4 patients. Hepatic perfusion showed identical patterns when ICG was compared with methylene blue. In 1 patient, additional extrahepatic perfusion was found using ICG, leading to further vessel ligation. Intraoperative ICG perfusion was concordant with 99 m-Tc perfusion scintigraphy.
Discussion
Liver and extrahepatic perfusion determined by ICG fluorescence imaging is concordant with blue dye perfusion and 99 m-Tc perfusion scintigraphy. Therefore, ICG fluorescence imaging is deemed a safe and reliable technique for perfusion testing during robot-assisted HAIP placement.
Graphical abstract
Publisher
Springer Science and Business Media LLC
Reference16 articles.
1. Leal JN, Kingham TP (2015) Hepatic artery infusion chemotherapy for liver malignancy. Surg Oncol Clin N Am 24(1):121–148. https://doi.org/10.1016/j.soc.2014.09.005
2. Link KH, Kornmann M, Leder G, Pillasch AF, Sunelaitis E, Schatz M et al (1999) Basic research supported developments of chemotherapy in nonresectable isolated colorectal liver metastases to a protocol of hepatic artery infusion using mitoxantrone, 5-FU+folinic acid and mitomycin C. Gan To Kagaku Ryoho 26(3):269–281
3. Qadan M, D’Angelica MI, Kemeny NE, Cercek A, Kingham TP (2017) Robotic hepatic arterial infusion pump placement. HPB 19(5):429–435. https://doi.org/10.1016/j.hpb.2016.12.015
4. Allen PJ, Nissan A, Picon AI, Kemeny N, Dudrick P, Ben-Porat L et al (2005) Technical complications and durability of hepatic artery infusion pumps for unresectable colorectal liver metastases: an institutional experience of 544 consecutive cases. J Am Coll Surg 201(1):57–65. https://doi.org/10.1016/j.jamcollsurg.2005.03.019
5. Karanicolas PJ, Metrakos P, Chan K, Asmis T, Chen E, Kingham TP et al (2014) Hepatic arterial infusion pump chemotherapy in the management of colorectal liver metastases: expert consensus statement. Curr Oncol 21(1):e129–e136. https://doi.org/10.3747/co.21.1577