Application of indocyanine green fluorescence imaging technique for hepatoblastoma resection in 13 children / 中华肝胆外科杂志

ABSTRACT

Objective:To analyse the application of indocyanine green (ICG) fluorescence contrast technique for resection of hepatoblastoma in children and to study its value in the application.Methods:The data of 13 children with pediatric hepatoblastoma who underwent open liver resection by using the ICG real-time image guided system were collected from June 2020 to October 2021 at the Children's Hospital of Nanjing Medical University. There were 10 males and 3 females. Their ages ranged from 5 days to 63 months, with a median of 22 months. The characteristics of the ICG imaging, surgical excision and postoperative pathology were analysed.Results:The tumors showed bright fluorescence in 13 patients. The border between the tumor and normal liver tissues was clear in 12 patients, and there was no difference between the background fluorescence of the liver and fluorescence of the tumor in one patient. Regular hepatic resection was performed in 6 patients and irregular hepatic resection in 7 patients under ICG fluorescence navigation. In one patient, the left half of the liver was resected, and there was no fluorescence on the transected surface of the liver remnant. The surface of the liver remnant was scattered with fluorescence showing multiple tumors, which were then locally enucleated. Twelve specimens which were fluorescently visualized were bisected with 8 specimens showing partial fluorescence visualization of the nodules within the tumor + annular visualization at the margins, and 4 patients showing annular fluorescence visualization at the tumor margins only. In 12 children, histopathological examination of the tissues at the site with circumferential imaging showed distorted, vacuolated and densely arranged hepatocytes resembling pseudo-envelope changes due to compression, but there were no tumor cells.Conclusion:The ICG fluorescence contrast technique was very effective for resection of childhood hepatoblastoma, and the ring fluorescence contrast of the tumor edge indicated the border for tumor resection. The ICG contrast plays an important role in navigating tumor resection, especially in patients with multiple tumor nodules.