Study on the application value of fluorescent laparoscopy in pancreatic tumor surgery

Shihang Xi; Wei Zhang; Daohai Qian; Chiyi He; Xueliang Zuo; Juan Cai; Lin Li; Huiming Cai; Chawla Akhil; Xiaoming Wang

doi:10.21037/gs-23-331

Study on the application value of fluorescent laparoscopy in pancreatic tumor surgery

Gland Surg. 2023 Oct 30;12(10):1403-1413. doi: 10.21037/gs-23-331. Epub 2023 Oct 26.

Authors

Shihang Xi^#¹, Wei Zhang^#², Daohai Qian¹, Chiyi He³, Xueliang Zuo⁴, Juan Cai⁵, Lin Li³, Huiming Cai⁶, Chawla Akhil⁷, Xiaoming Wang¹

Affiliations

¹ Department of Hepatobiliary Surgery, First Affiliated Hospital of Wannan Medical College, Wuhu, China.
² Jiangsu Institute of Medical Device Testing, Nanjing, China.
³ Department of Gastroenterology, First Affiliated Hospital of Wannan Medical College, Wuhu, China.
⁴ Department of Gastrointestinal Surgery, First Affiliated Hospital of Wannan Medical College, Wuhu, China.
⁵ Department of Oncology, First Affiliated Hospital of Wannan Medical College, Wuhu, China.
⁶ Nanjing Nuoyuan Medical Devices Co., Ltd., Nanjing, China.
⁷ Division of Surgical Oncology, Northwestern University Feinberg School of Medicine, Northwestern Medicine Cancer Centers, Robert H. Lurie Comprehensive Cancer Center, Chicago, IL, USA.

^# Contributed equally.

Abstract

Background: Fluorescent laparoscopy is rarely used in pancreatic surgery. The aim of this study was to investigate the value of fluorescent laparoscopy in pancreatic tumor surgery.

Methods: A total of 19 patients with pancreatic tumors who were treated in the Department of Hepatobiliary Surgery at the First Affiliated Hospital of Wannan Medical College from January 2021 to August 2022 were selected. Fluorescent laparoscopy was used intraoperatively, and the imaging characteristics of different tumors were recorded and analyzed.

Results: Among the 19 participants, postoperative pathology confirmed 12 cases of pancreatic cancer (8 cases of moderately differentiated adenocarcinoma, 3 cases of moderately-poorly differentiated adenocarcinoma, and 1 case of acinar cell carcinoma), 4 cases of pancreatic cystic tumors (1 case of microcystic serous cystadenoma, 1 case of serous cystadenoma, 1 case of solid pseudopapillary tumor, and 1 case of solid-cystic pseudopapillary tumor), 1 case of pancreatic neuroendocrine tumor (G1 stage), and 2 cases of inflammatory lesions. There were 8 cases of pancreaticoduodenectomy, 6 cases of distal pancreatectomy, 3 cases of middle pancreatectomy, 1 case of local pancreatectomy, and 1 case of duodenum-preserving pancreatic head resection. One minute after intravenous injection of indocyanine green (ICG), 10 of the 12 patients with pancreatic cancer showed tumor peritumor imaging; 2 cases of pancreatic serous cystic tumors did not show imaging; 2 cases of solid pseudopapillary tumors had tumor body imaging; 1 case of neuroendocrine tumor had tumor body imaging, with complete fluorescence imaging after specimen dissection; there were 2 cases pathologically confirmed as inflammatory lesions, 1 case with tumor body imaging, and 1 case with capsule imaging.

Conclusions: By reasonably controlling the administration time and dose of ICG during surgery, some pancreatic tumors can be fluorescently imaged, which is beneficial for intraoperative tumor localization and margin determination.

Keywords: Fluorescent laparoscopy; indocyanine green (ICG); pancreatic tumors.