Minimally invasive, Indocyanine-Guided Metastasectomy in patients with Colorectal Liver Metastases

Radical surgical resection is still seen as the ‘gold standard’ and the only potential for cure in patients diagnosed with colorectal liver metastases. Currently 5-year survival rates are between 35-60% in patients undergoing surgery with curative intent. Achieving a radical resection (>1mm) shows superior survival in patients undergoing surgery. Therefore, improving radical resection rates has the potential to improve overall survival rates.
According to data from the Dutch Hepato Biliary Audit, up to 31% of the patients underwent an ‘intention-to-treat’ laparoscopic resection in 2016 in the Netherlands. This is expected to increase in the coming years. During laparoscopy the surgeon is limited in both visible and tactile information for determination of the resection margin of colorectal liver metastases (CRLM). Currently, near infrared fluorescent (NIRF) imaging with ICG is used to determine the resection margin in all participating centres as standard-of-care. Surgeons experience this technique with real-time fluorescent overlay laparoscopy as user friendly, and we have seen promising results so far. Although the fluorescent rim is already used for resection margin assessment, the radical resection rates have not been documented before.
Due to the accumulation of ICG inside immature hepatocytes surrounding the CRLM, a specific fluorescent ‘rim’ is present around the metastasis. Preliminary data show these fluorescent rims are present around all CRLM. Therefore, the use of NIRF imaging during laparoscopic resections of CRLM has the potential to increase radical resection rates.

NIRF imaging during minimally invasive resection of liver metastases can aid in achieving higher radical resection rates in patients with colorectal liver metastases.

Surgery and follow-up