Over the past ten years,numerous papers have been published on the use of indocyanine green(ICG)fluorescence in liver surgery for hepatocellular carcinoma(HCC).There are many different applications.The first involves ...Over the past ten years,numerous papers have been published on the use of indocyanine green(ICG)fluorescence in liver surgery for hepatocellular carcinoma(HCC).There are many different applications.The first involves targeting superficial tumors in patients with macronodular cirrhosis and an irregular liver surface.In a minimally invasive setting,the lack of tactile feedback on the hepatic surface makes detecting subcapsular HCC with ultrasound alone challenging.ICG fusion images can mimic the tactile feedback of the hand and act as an ultrasound booster.ICG fluorescence can be used to evaluate tumor residues after minimally invasive thermal ablation.ICG fluorescence imaging can also be used to identify the grade of HCC early on and evaluate the microinvasive component.展开更多
Cholecystectomy is extensively employed for the treatment of various gallbladder diseases,including symptomatic cholelithiasis,asymptomatic cholelithiasis with a high risk of gallbladder cancer or complications,non-ca...Cholecystectomy is extensively employed for the treatment of various gallbladder diseases,including symptomatic cholelithiasis,asymptomatic cholelithiasis with a high risk of gallbladder cancer or complications,non-calculous cholecystitis,gallbladder polyps larger than 1.0 cm,and porcelain gallbladder,etc.Currently,laparoscopic cholecystectomy(LC)constitutes over 95%of all cholecystectomy procedures,which is the preferred approach for gallbladder surgery[1,2].展开更多
Objective Almost 15%of prostate cancer(PCa)patients were found to have lymph node metastases(LNMs),which are associated with higher risk of biochemical recurrence.Using indocyanine green(ICG)for the sentinel node biop...Objective Almost 15%of prostate cancer(PCa)patients were found to have lymph node metastases(LNMs),which are associated with higher risk of biochemical recurrence.Using indocyanine green(ICG)for the sentinel node biopsy(SNB)before surgery was proposed to detect LNMs in PCa patients.However,its diagnostic performance still remains controversial.This study aimed to investigate the diagnostic performance of ICG for the SNB in PCa.Methods This systematic review and meta-analysis has been reported in line with the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines.The protocol has been registered in the International Prospective Register of Systematic Reviews database,and the register number is CRD42023421911.Four bibliographic databases were searched,i.e.,PubMed,EMBASE,Cochrane Library,and Web of Science,to retrieve articles studying the diagnostic performance of ICG for the SNB in PCa from the inception to Sep 9,2023.We calculated the pooled sensitivity,specificity,likelihood ratios,diagnostic odds ratios and their 95%confidence intervals(CIs).Subgroup analyses and meta-regression analyses were also conducted.Results A total of 17 articles from databases are enrolled in this study.Using lymph node-based data,our results showed that the pooled sensitivity and specificity of applying ICG alone in PCa were 71%(95%CI 52%–85%)and 68%(95%CI 64%–72%),respectively.The pooled sensitivity and specificity of applying ICG-technetium-99m-nanocolloid in PCa were 49%(95%CI 39%–59%)and 69%(95%CI 67%–71%),respectively.展开更多
In this editorial,we comment on the article by Li et al.We specifically focus on the novel use of multicolor near-infrared fluorescence imaging(MCFI)with indocyanine green in laparoscopic cholecystectomy,which is an i...In this editorial,we comment on the article by Li et al.We specifically focus on the novel use of multicolor near-infrared fluorescence imaging(MCFI)with indocyanine green in laparoscopic cholecystectomy,which is an innovative approach for enhancing biliary visualization during laparoscopic cholecystectomy.This study also highlighted the limitations of conventional single-color fluorescence imaging(SCFI),which relies solely on a green fluorescence signal,leading to challenges such as visual fatigue and difficulty in distinguishing biliary structures from background hepatic tissue.Given the complex anatomy of the biliary system and the challenges of visual fatigue encountered with SCFI,MCFI addresses these issues by enabling the differentiation of biliary structures by mapping the fluorescence intensity across a unique blue-to-purple color spectrum,thus improving the clarity of anatomical structures and reducing the visual strain for surgeons.We also focus specifically on the complications and cautious usage of indocyanine green in this context,as well as the advantages and disadvantages of MCFI and SCFI.Overall,MCFI represents a significant advancement in fluorescence-guided surgery,with the potential to become a standard imaging modality for safer and more effective laparoscopic procedures.展开更多
Gastric cancer(GC)ranks among the most common and deadly malignancies globally.Surgical resection with lymph node(LN)dissection is the primary treatment.The accuracy of LN dissection is essential to reduce postoperati...Gastric cancer(GC)ranks among the most common and deadly malignancies globally.Surgical resection with lymph node(LN)dissection is the primary treatment.The accuracy of LN dissection is essential to reduce postoperative complications and mortality.Therefore,improving the quality of LN dissection in GC surgery and refining postoperative LN staging have been the focus of clinical attention.Indocyanine green(ICG)fluorescence imaging serves as a vital clinical tracing technique in GC surgery.It enables accurate tumor localization,enhances the completeness of LN dissection,and evaluates anastomotic blood supply after digestive tract reconstruction.These benefits collectively improve surgical outcomes and lower recurrence rates.This article examines the principles of ICG fluorescence imaging and its necessity in GC tracing surgery.Compared to conventional tracers,ICG offers superior safety and lower toxicity,with robust evidence supporting its clinical efficacy.This technology represents a paradigm shift in GC surgery.Current studies optimize ICG delivery protocols,such as injection time and dose,and integrate it with emerging technologies like robotic systems to improve LN detection rates.This article demonstrates the safety and efficacy of ICG as a tracer,which is poised to advance the precision of GC surgery and improve patient outcomes.展开更多
Indocyanine green fluorescence imaging technology has been increasingly utilized in rectal surgery in recent years.As a safe tracer,indocyanine green can facilitate lymph node tracing,assess the blood supply at anasto...Indocyanine green fluorescence imaging technology has been increasingly utilized in rectal surgery in recent years.As a safe tracer,indocyanine green can facilitate lymph node tracing,assess the blood supply at anastomotic sites,and localize tumour lesions during laparoscopic surgery,thereby resulting in favourable outcomes.This technology helps surgeons to achieve more precise diagnoses and treatments in laparoscopic procedures,thus ultimately benefiting patients.However,the current application of indocyanine green fluorescence imaging technology still lacks standardized regulations,and certain effects remain contentious.This study provides a comprehensive review of the application of indocyanine green in laparoscopic surgery for rectal cancer based on the pertinent literature.展开更多
Dear Editor,Radical cystectomy(RC)remains the standard treatment for muscle-invasive bladder cancer[1].However,urinary diversion after RC can lead to a range of postoperative complications,including parastomal hernia,...Dear Editor,Radical cystectomy(RC)remains the standard treatment for muscle-invasive bladder cancer[1].However,urinary diversion after RC can lead to a range of postoperative complications,including parastomal hernia,incontinence,urinary retention,recurrent urinary tract infections,and metabolic disorders,significantly impacting patients'quality of life[2].Partial cystectomy(PC)is a bladdersparing alternative for patients who cannot accept RC and has been utilized in managing muscle-invasive bladder cancer since the last century.However,the application of PC has always been a subject of controversy in clinical practice due to the high recurrence rate.In a matched case-control analysis conducted by Knoedler et al.[3],38%of the patients experienced intravesical tumor recurrence,and 19%of the patients ultimately underwent RC.Another study in the Memorial Sloan-Kettering Cancer Center showed that 22 of 58 patients who received PC experienced superficial or advanced recurrence[4].展开更多
BACKGROUND Improving the intraoperative and postoperative performance of laparoscopic hepatectomy was quite a challenge for liver surgeons.AIM To determine the benefits of indocyanine green(ICG)fluorescence imaging in...BACKGROUND Improving the intraoperative and postoperative performance of laparoscopic hepatectomy was quite a challenge for liver surgeons.AIM To determine the benefits of indocyanine green(ICG)fluorescence imaging in patients with hepatocellular carcinoma(HCC)who underwent laparoscopic hepatectomy during and after surgery.METHODS We retrospectively collected the clinicopathological data of 107 patients who successfully underwent laparoscopic hepatectomy at Zhongshan Hospital(Xiamen),Fudan University from June 2022 to June 2023.Whether using the ICG fluorescence imaging technique,we divided them into the ICG and non-ICG groups.To eliminate statistical bias,a 1:1 propensity score matching analysis was conducted.The comparison of perioperative outcomes,including inflammationrelated markers and progression-free survival,was analyzed statistically.RESULTS Intraoperatively,the ICG group exhibited lower blood loss,a shorter surgical time,lower hepatic inflow occlusion(HIO)frequency,and a shorter total HIO time.Postoperatively,the participation of ICG resulted in a shorter duration of hospitalization(6.5 vs 7.6 days,P=0.03)and postoperative inflammatory response attenuation(lower neutrophil-lymphocyte ratio on the first day after surgery and platelet-lymphocyte ratio on the third day,P<0.05).Although the differences were not significant,the levels of all inflammation-related markers were lower in the ICG group.The rates of postoperative complications and the survival analyses,including progression-free and overall survivals showed no significant difference between the groups.CONCLUSION The involvement of ICG fluorescence imaging may lead to improved perioperative outcomes,especially postoperative inflammatory response attenuation,and ultimately improve HCC patients’recovery after surgery.展开更多
BACKGROUND Intraoperative and postoperative biliary injuries remain significant complications of laparoscopic common bile duct exploration(LCBDE).Indocyanine green(ICG)has been shown to significantly reduce injuries c...BACKGROUND Intraoperative and postoperative biliary injuries remain significant complications of laparoscopic common bile duct exploration(LCBDE).Indocyanine green(ICG)has been shown to significantly reduce injuries caused by intraoperative operational errors.We found that the J-tube can reduce postoperative strictures and injuries to the common bile duct.At this moment,we aim to analyze and compare the complications,efficacy,short-term outcomes,and feasibility of these two adjunctive tools for LCBDE.AIM To evaluate the efficacy of ICG fluorescence imaging In LCBDE and J-tube drainage for patients with common bile duct stones.METHODS We retrospectively collected the clinical case data of patients who were treated at the Hepatobiliary Surgery Department of the Third People’s Hospital of Nantong,affiliated with Nantong University,from January 2016 to January 2021 due to gallbladder stones with choledocholithiasis and who underwent LCBDE combined with a primary suture and either J-tube or T-tube drainage.The patients were divided into groups:Traditional white-light laparoscopy+T-tube group(WL+T-tube),traditional WL+J-tube group,fluorescent laparoscopy+T-tube group(ICG+T-tube)and fluorescent laparoscopy+J-tube group(ICG+J-tube).The preoperative and postoperative clinical case data,laboratory examination data,and intraoperative and postoperative complications(including postoperative bile leakage,electrolyte disturbances,biliary peritonitis,and postoperative infections)and other relevant indicators were compared.RESULTS A total of 198 patients(112 males and 86 females)were included in the study,with 74 patients in the WL+T-tube,47 in the WL+J-tube,42 in the ICG+T-tube,and 35 in the ICG+J-tube.Compared with the other groups,the ICG+J had significantly shorter operation time(114 minutes,P=0.001),less blood loss(42 mL,P=0.02),shorter postoperative hospital stays(7 days,P=0.038),and lower surgical costs(China yuan 30178,P=0.001).Furthermore,patients were subdivided into two groups based on whether a T-tube or J-tube was placed during the surgery.By the third postoperative day,the aspartate transaminase,glutamic pyruvic transaminase,total bilirubin,and direct bilirubin levels were lower in the J-tube group than in the T-tube group(P<0.001).At last,follow-up observations showed that the incidence of biliary strictures at three months postoperatively was significantly lower in the J-tube group than in the T-tube group(P=0.002).CONCLUSION ICG fluorescence imaging in laparoscopic cholecystectomy with common bile duct exploration and J-tube drainage facilitates rapid identification of biliary anatomy and variations,reducing intraoperative bile duct injury,blood loss,surgery duration,and postoperative bile duct stenosis rates,supporting its clinical adoption.展开更多
To the Editor:Laparoscopic liver resection(LLR)is widely used as a standard procedure for liver malignancies and benign diseases.Consensus guidelines stated that LLR may be feasible and safe in experienced centers.Evi...To the Editor:Laparoscopic liver resection(LLR)is widely used as a standard procedure for liver malignancies and benign diseases.Consensus guidelines stated that LLR may be feasible and safe in experienced centers.Evidence has shown that LLR is less invasive and has bet-ter patient prognosis than conventional procedures[1].However,laparoscopic anatomic liver resection(LALR)such as segment 8(S8)resection is still challenging due to difficulties in segmental mapping and surgical techniques[2,3].Liver S8 is in a deep-seated area surrounded by the ribs and the diaphragm,and closely con-nected to the right and middle hepatic veins and inferior vena cava.Furthermore,the Glissonean pedicle of segment 8(G8)is lo-cated deep in the liver parenchyma,lacking anatomical landmarks,and making forceps manipulation difficult.Therefore,LALR-S8 has been described as the most challenging procedure[4].展开更多
In this work, we put forward a new and universal approach, i.e., cyanine ketone method, for fabricating meso–aryl heptamethine indocyanines, which is so simple that the treatment of the easy-to-get cyanine ketones wi...In this work, we put forward a new and universal approach, i.e., cyanine ketone method, for fabricating meso–aryl heptamethine indocyanines, which is so simple that the treatment of the easy-to-get cyanine ketones with various aromatic lithium(Ar Li), followed by acidification, could straightforwardly give rise to the products in one-pot way. Importantly, due to the strong nucleophilicity of Ar Li, a series of bulky hydrophilic aromatic groups can be facilely integrated into the meso–position of heptamethine indocyanines, not only effectively inhibiting the undesired dye self-aggregation but also largely improving the water-solubility. Using one of anti-aggregation meso–aryl heptamethine indocyanines, we fabricated a dye-antibody conjugate for in vivo imaging tumor in a mouse model and achieved a high tumor-tonormal tissue ratio. The work laid a chemical foundation for constructing various meso–aryl heptamethine indocyanines, facilitating the advanced imaging and therapeutic applications in future.展开更多
Laparoscopic cholecystectomy(LC)remains one of the most commonly performed procedures in adult and paediatric populations.Despite the advances made in intraoperative biliary anatomy recognition,iatrogenic bile duct in...Laparoscopic cholecystectomy(LC)remains one of the most commonly performed procedures in adult and paediatric populations.Despite the advances made in intraoperative biliary anatomy recognition,iatrogenic bile duct injuries during LC represent a fatal complication and consist an economic burden for healthcare systems.A series of methods have been proposed to prevent bile duct injury,among them the use of indocyanine green(ICG)fluorescence.The most commonly reported method of ICG injection is the intravenous administration,while literature is lacking studies investigating the direct intragallbladder ICG injection.This narrative mini-review aims to assess the potential applications,usefulness,and limitations of intragallbladder ICG fluorescence in LC.Authors screened the available international literature to identify the reports of intragallbladder ICG fluorescence imaging in minimally invasive cholecystectomy,as well as special issues regarding its use.Literature search retrieved four prospective cohort studies,three case-control studies,and one case report.In the three case-control studies selected,intragallbladder near-infrared cholangiography(NIRC)was compared with standard LC under white light,with intravenous administration of ICG for NIRC and with standard intraoperative cholangiography(IOC).In total,133 patients reported in the literature have been administered intragallbladder ICG administration for biliary mapping during LC.Literature includes several reports of intragallbladder ICG administration,but a standardized technique has not been established yet.Published data suggest that NIRC with intragallbladder ICG injection is a promising method to achieve biliary mapping,overwhelming limitations of IOC including intervention and radiation exposure,as well as the high hepatic parenchyma signal and time interval needed in intravenous ICG fluorescence.Evidence-based guidelines on the role of intragallbladder ICG fluorescence in LC require the assessment of further studies and multicenter data collection into large registries.展开更多
BACKGROUND Preoperative evaluation of future remnant liver reserves is important for safe hepatectomy.If the remnant is small,preoperative portal vein embolization(PVE)is useful.Liver volume analysis has been the prim...BACKGROUND Preoperative evaluation of future remnant liver reserves is important for safe hepatectomy.If the remnant is small,preoperative portal vein embolization(PVE)is useful.Liver volume analysis has been the primary method of preoperative evaluation,although functional examination may be more accurate.We have used the functional evaluation liver using the indocyanine green plasma clearance rate(KICG)and 99mTc-galactosyl human serum albumin single-photon emission computed tomography(99mTc-GSA SPECT)for safe hepatectomy.AIM To analyze the safety of our institution’s system for evaluating the remnant liver reserve.METHODS We retrospectively reviewed the records of 23 patients who underwent preoperative PVE.Two types of remnant liver KICG were defined as follows:Anatomical volume remnant KICG(a-rem-KICG),determined as the remnant liver anatomical volume rate×KICG;and functional volume remnant KICG(frem-KICG),determined as the remnant liver functional volume rate based on 99mTc-GSA SPECT×KICG.If either of the remnant liver KICGs were>0.05,a hepatectomy was performed.Perioperative factors were analyzed.We defined the marginal group as patients with a-rem-KICG of<0.05 and a f-rem-KICG of>0.05 and compared the postoperative outcomes between the marginal and not marginal(both a-rem-KICG and f-rem-KICG>0.05)groups.RESULTS All 23 patients underwent planned hepatectomies.Right hepatectomy,right trisectionectomy and left trisectionectomy were in 16,6 and 1 cases,respectively.The mean of blood loss and operative time were 576 mL and 474 min,respectively.The increased amount of frem-KICG was significantly larger than that of a-rem-KICG after PVE(0.034 vs 0.012,P=0.0273).The not marginal and marginal groups had 17(73.9%)and 6(26.1%)patients,respectively.The complications of Clavian-Dindo classification grade II or higher and post-hepatectomy liver failure were observed in six(26.1%)and one(grade A,4.3%)patient,respectively.The 90-d mortality was zero.The marginal group had no significant difference in postoperative outcomes(prothrombin time/international normalised ratio,total bilirubin,complication,post-hepatectomy liver failure,hospital stay,90-d,and mortality)compared with the not-marginal group.CONCLUSION Functional evaluation of the remnant liver enabled safe hepatectomy and may extend the indication for hepatectomy after PVE treatment.展开更多
In recent years,the use of fluorescence-guided surgery(FGS)to treat benign and malignant visceral,hepatobiliary and pancreatic neoplasms has significantly increased.FGS relies on the fluorescence signal emitted by inj...In recent years,the use of fluorescence-guided surgery(FGS)to treat benign and malignant visceral,hepatobiliary and pancreatic neoplasms has significantly increased.FGS relies on the fluorescence signal emitted by injected substances(fluorophores)after being illuminated by ad hoc laser sources to help guide the surgical procedure and provide the surgeon with real-time visualization of the fluorescent structures of interest that would be otherwise invisible.This review surveys and discusses the most common and emerging clinical applications of indocyanine green(ICG)-based fluorescence in visceral,hepatobiliary and pancreatic surgery.The analysis,findings,and discussion presented here rely on the authors'significant experience with this technique in their medical institutions,an up-to-date review of the most relevant articles published on this topic between 2014 and 2018,and lengthy discussions with key opinion leaders in the field during recent conferences and congresses.For each application,the benefits and limitations of this technique,as well as applicable future directions,are described.The imaging of fluorescence emitted by ICG is a simple,fast,relatively inexpensive,and harmless tool with numerous different applications in surgery for both neoplasms and benign pathologies of the visceral and hepatobiliary systems.The ever-increasing availability of visual systems that can utilize this tool will transform some of these applications into the standard of care in the near future.Further studies are needed to evaluate the strengths and weaknesses of each application of ICG-based fluorescence imaging in abdominal surgery.展开更多
BACKGROUND: The indocyanine green (ICG) clearance test (clearance rate (K) and retention rate at 15 minutes (R(15))) is a sensitive indicator to evaluate liver function. The model for end-stage liver disease (MELD) sc...BACKGROUND: The indocyanine green (ICG) clearance test (clearance rate (K) and retention rate at 15 minutes (R(15))) is a sensitive indicator to evaluate liver function. The model for end-stage liver disease (MELD) score has emerged as a useful tool for estimating the mortality of patients awaiting liver transplantation and has recently been validated on patients with liver diseases of various etiologies and severity. In this study, we investigated the correlation between the ICG clearance test and MELD score of patients with liver cirrhosis. METHODS: From June 2007 to March 2008, 52 patients with liver cirrhosis admitted to our center were classified into Child-Pugh class A (8 patients), B (14) and C (30). The ICG clearance test (K value and R(15)) was performed by ICG pulse spectrophotometry (DDG-3300K), and the MELD scores of patients were calculated. RESULTS: As the Child-Pugh classification of liver function gradually deteriorated, the K value decreased, while R(15) and MELD score increased. There were significant statistical differences in K value, R(15) and MELD score in patients with different Child-Pugh classifications. Significant correlations were found between the parameters of the ICG clearance test (K value and R(15)) and MELD score. A negative correlation was observed between K value and MELD score (r=-0.892, P < 0.05), while a positive correlation was observed between R(15) and MELD score (r=0.804, P < 0.05). CONCLUSIONS: The ICG clearance test and MELD score are good parameters for evaluating liver function. Moreover, K value and R(15) have significant correlations with MELD score, especially the K value, which may be a convenient and appropriate indicator to evaluate liver function of patients with liver cirrhosis.展开更多
BACKGROUND: Acute liver failure(ALF) is an acute severe deterioration of liver function with high mortality. Early and accurate prognostic assessment of patients with ALF is critically important. Although the model fo...BACKGROUND: Acute liver failure(ALF) is an acute severe deterioration of liver function with high mortality. Early and accurate prognostic assessment of patients with ALF is critically important. Although the model for end-stage liver disease(MELD) scores and King’s College Hospital(KCH) criteria are well-accepted as predictive tools, their accuracy is unsatisfactory.The indocyanine green(ICG) clearance test(ICGR15, ICG retention rate at the 15 minutes) is a sensitive indicator of liver function. In this study, we investigated the efficacy of the ICGR15 for the short-term prognosis in patients with ALF. We compared the predictive value of ICGR15 with the MELD scores and KCH criteria.METHODS: Sixty-nine patients who had been diagnosed with ALF were recruited retrospectively. ICGR15 had been performed by ICG pulse spectrophotometry and relevant clinical and laboratory indices were analyzed within 24 hours of diagnosis.In addition, the MELD scores and KCH criteria were calculated.RESULTS: The three-month mortality of all patients was 47.83%.Age, serum total bilirubin and creatinine concentrations,international normalized ratio for prothrombin time, ICGR15,MELD scores and KCH criteria differed significantly between surviving and deceased patients. A positive correlation was observed between ICGR15 and MELD scores(r=0.328, P=0.006).The ICGR15-MELD model, Logit(P)=0.096×ICGR15+0.174 ×MELD score–9.346, was constructed by logistic regression analysis. The area under the receiver operating characteristic curve was 0.855. When set the cut-off point to-0.4684, the sensitivity was 87.90% and specificity, 72.20%. The area under the receiver operating characteristic curve of the ICGR15-MELD model(0.855) was significantly higher than that of the ICGR15(0.793), MELD scores(0.776) and KCH criteria(0.659).Based on this cut-off value, the patients were divided into two groups. The mortality was 74.36% in the first group(ICGR15-MELD≥-0.4686) and 13.33% in the second group(ICGR15-MELD<-0.4686), with a significant difference between the two groups(χ2=25.307, P=0.000).CONCLUSION: The ICGR15-MELD model is superior to the ICGR15, MELD scores, and KCH criteria in predicting the shortterm prognosis of patients with ALF.展开更多
Objective:This randomized study aimed to compare the clinical efficacy between the novel dual tracer composed of indocyanine green(ICG)and blue dye(BD)and the conventional dual tracer composed of radioisotope and BD f...Objective:This randomized study aimed to compare the clinical efficacy between the novel dual tracer composed of indocyanine green(ICG)and blue dye(BD)and the conventional dual tracer composed of radioisotope and BD for sentinel lymph node(SLN)mapping in patients with breast cancer.Methods:This study enrolled 471 clinically lymph node-negative patients with primary breast cancer.All patients underwent mastectomy,and those undergoing sentinel lymph node biopsy(SLNB)were randomized to receive blue dye plus radioisotope(RB group)or BD plus ICG(IB group).The detection performances on SLN identification rate,positive SLN counts,detection sensitivity,and false-negative rate were compared between the two groups.Results:In the IB group,97%(194/200)of the patients who underwent the ICG and BD dual tracer injection showed fluorescentpositive lymphatic vessels within 2–5 min.The identification rate of SLNs was comparable between the IB group(99.0%,198/200)and the RB group(99.6%,270/271)(P=0.79).No significant differences were observed in the identification rate of metastatic SLNs(22.5%vs.22.9%,P>0.05,RB group vs.IB group,the same below),positive SLN counts(3.72±2.28 vs.3.91±2.13,P>0.05),positive metastatic SLN counts(0.38±0.84 vs.0.34±0.78,P>0.05),SLNB detection sensitivity(94.4%vs.92.5%,P>0.05),or false-negative rate(5.6%vs.7.5%,P>0.05)between the two groups.Conclusions:ICG can be used as a promising alternative tracer for radioisotope in SLN mapping,and when it is combined with BD in lymphangiography,it offers comparable detection sensitivity compared to the conventional lymphatic mapping strategies that are widely used in clinical practice.展开更多
Indocyanine green(ICG) kinetics(PDR/R15) used to quantitatively assess hepatic function in the perioperative period of major resective surgery and liver transplantation have been the object of an extensive, updated an...Indocyanine green(ICG) kinetics(PDR/R15) used to quantitatively assess hepatic function in the perioperative period of major resective surgery and liver transplantation have been the object of an extensive, updated and critical review. New, non invasive bedside monitors(pulse dye densitometry technology) make this opportunity widely available in clinical practice. After having reviewed basic concepts of hepatic clearance, we analysed the most common indications ICG kinetic parameters have nowadays in clinical practice, focusing in particular on the diagnostic and prognostic role of PDR and R15 in the perioperative period of major liver surgery and liver transplantation. As recently pointed out, even if of extreme interest, ICG clearance parameters have still some limitations, to be considered when using these tests.展开更多
BACKGROUND As one effective treatment for lateral pelvic lymph node(LPLN)metastasis(LPNM),laparoscopic LPLN dissection(LPND)is limited due to the complicated anatomy of the pelvic sidewall and various complications af...BACKGROUND As one effective treatment for lateral pelvic lymph node(LPLN)metastasis(LPNM),laparoscopic LPLN dissection(LPND)is limited due to the complicated anatomy of the pelvic sidewall and various complications after surgery.With regard to improving the accuracy and completeness of LPND as well as safety,we tried an innovative method using indocyanine green(ICG)visualized with a near-infrared(NIR)camera system to guide the detection of LPLNs in patients with middle-low rectal cancer.AIM To investigate whether ICG-enhanced NIR fluorescence-guided imaging is a better technique for LPND in patients with rectal cancer.METHODS A total of 42 middle-low rectal cancer patients with clinical LPNM who underwent total mesorectal excision(TME)and LPND between October 2017 and March 2019 at our institution were assessed and divided into an ICG group and a non-ICG group.Clinical characteristics,operative outcomes,pathological outcomes,and postoperative complication information were compared and analysed between the two groups.RESULTS Compared to the non-ICG group,the ICG group had significantly lower intraoperative blood loss(55.8±37.5 mL vs 108.0±52.7 mL,P=0.003)and a significantly larger number of LPLNs harvested(11.5±5.9 vs 7.1±4.8,P=0.017).The LPLNs of two patients in the non-IVG group were residual during LPND.In addition,no significant difference was found in terms of LPND,LPNM,operative time,conversion to laparotomy,preoperative complication,or hospital stay(P>0.05).CONCLUSION ICG-enhanced NIR fluorescence-guided imaging could be a feasible and convenient technique to guide LPND because it could bring specific advantages regarding the accuracy and completeness of surgery as well as safety.展开更多
AIM To investigate near-infrared photoimmunotherapeutic effect mediated by an anti-tissue factor(TF) antibody conjugated to indocyanine green(ICG) in a pancreatic cancer model.METHODS Near-infrared photoimmunotherapy(...AIM To investigate near-infrared photoimmunotherapeutic effect mediated by an anti-tissue factor(TF) antibody conjugated to indocyanine green(ICG) in a pancreatic cancer model.METHODS Near-infrared photoimmunotherapy(NIR-PIT) is a highly selective tumor treatment that utilizes an antibody-photosensitizer conjugate administration, followed by NIR light exposure. Anti-TF antibody 1849-ICG conjugate was synthesized by labeling of rat IgG2 b anti-TF monoclonal antibody 1849(anti-TF 1849) to a NIR photosensitizer,ICG. The expression levels of TF in two human pancreatic cancer cell lines were examined by western blotting. Specific binding of the 1849-ICG to TF-expressing BxPC-3 cells was examined by fluorescence microscopy. NIR-PITinduced cell death was determined by cell viability imaging assay. In vivo longitudinal fluorescence imaging was used to explore the accumulation of 1849-ICG conjugate in xenograft tumors. To examine the effect of NIRPIT, tumor-bearing mice were separated into 5 groups:(1) 100 μg of 1849-ICG i.v. administration followed by NIR light exposure(50 J/cm2) on two consecutive days(Days 1 and 2);(2) NIR light exposure(50 J/cm2) only on two consecutive days(Days 1 and 2);(3) 100 μg of 1849-ICG i.v. administration;(4) 100 μg of unlabeled antiTF 1849 i.v. administration; and(5) the untreated control. Semiweekly tumor volume measurements, accompanied with histological and immunohistochemical(IHC) analyses of tumors, were performed 3 d after the 2nd irradiation with NIR light to monitor the effect of treatments. RESULTS High TF expression in BxPC-3 cells was observed via western blot analysis, concordant with the observed preferential binding with intracellular localization of 1849-ICG via fluorescence microscopy. NIR-PIT-induced cell death was observed by performing cell viability imaging assay. In contrast to the other test groups, tumor growth was significantly inhibited by NIR-PIT with a statistically significant difference in relative tumor volumes for 27 d after the treatment start date [2.83 ± 0.38(NIR-PIT) vs 5.42 ± 1.61(Untreated), vs 4.90 ± 0.87(NIR), vs 4.28 ±1.87(1849-ICG), vs 4.35 ± 1.42(anti-TF 1849), at Day 27, P < 0.05]. Tumors that received NIR-PIT showed evidence of necrotic cell death-associated features upon hematoxylin-eosin staining accompanied by a decrease in Ki-67-positive cells(a cell proliferation marker) by IHC examination.CONCLUSION The TF-targeted NIR-PIT with the 1849-ICG conjugate can potentially open a new platform for treatment of TF-expressing pancreatic cancer.展开更多
文摘Over the past ten years,numerous papers have been published on the use of indocyanine green(ICG)fluorescence in liver surgery for hepatocellular carcinoma(HCC).There are many different applications.The first involves targeting superficial tumors in patients with macronodular cirrhosis and an irregular liver surface.In a minimally invasive setting,the lack of tactile feedback on the hepatic surface makes detecting subcapsular HCC with ultrasound alone challenging.ICG fusion images can mimic the tactile feedback of the hand and act as an ultrasound booster.ICG fluorescence can be used to evaluate tumor residues after minimally invasive thermal ablation.ICG fluorescence imaging can also be used to identify the grade of HCC early on and evaluate the microinvasive component.
文摘Cholecystectomy is extensively employed for the treatment of various gallbladder diseases,including symptomatic cholelithiasis,asymptomatic cholelithiasis with a high risk of gallbladder cancer or complications,non-calculous cholecystitis,gallbladder polyps larger than 1.0 cm,and porcelain gallbladder,etc.Currently,laparoscopic cholecystectomy(LC)constitutes over 95%of all cholecystectomy procedures,which is the preferred approach for gallbladder surgery[1,2].
文摘Objective Almost 15%of prostate cancer(PCa)patients were found to have lymph node metastases(LNMs),which are associated with higher risk of biochemical recurrence.Using indocyanine green(ICG)for the sentinel node biopsy(SNB)before surgery was proposed to detect LNMs in PCa patients.However,its diagnostic performance still remains controversial.This study aimed to investigate the diagnostic performance of ICG for the SNB in PCa.Methods This systematic review and meta-analysis has been reported in line with the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines.The protocol has been registered in the International Prospective Register of Systematic Reviews database,and the register number is CRD42023421911.Four bibliographic databases were searched,i.e.,PubMed,EMBASE,Cochrane Library,and Web of Science,to retrieve articles studying the diagnostic performance of ICG for the SNB in PCa from the inception to Sep 9,2023.We calculated the pooled sensitivity,specificity,likelihood ratios,diagnostic odds ratios and their 95%confidence intervals(CIs).Subgroup analyses and meta-regression analyses were also conducted.Results A total of 17 articles from databases are enrolled in this study.Using lymph node-based data,our results showed that the pooled sensitivity and specificity of applying ICG alone in PCa were 71%(95%CI 52%–85%)and 68%(95%CI 64%–72%),respectively.The pooled sensitivity and specificity of applying ICG-technetium-99m-nanocolloid in PCa were 49%(95%CI 39%–59%)and 69%(95%CI 67%–71%),respectively.
文摘In this editorial,we comment on the article by Li et al.We specifically focus on the novel use of multicolor near-infrared fluorescence imaging(MCFI)with indocyanine green in laparoscopic cholecystectomy,which is an innovative approach for enhancing biliary visualization during laparoscopic cholecystectomy.This study also highlighted the limitations of conventional single-color fluorescence imaging(SCFI),which relies solely on a green fluorescence signal,leading to challenges such as visual fatigue and difficulty in distinguishing biliary structures from background hepatic tissue.Given the complex anatomy of the biliary system and the challenges of visual fatigue encountered with SCFI,MCFI addresses these issues by enabling the differentiation of biliary structures by mapping the fluorescence intensity across a unique blue-to-purple color spectrum,thus improving the clarity of anatomical structures and reducing the visual strain for surgeons.We also focus specifically on the complications and cautious usage of indocyanine green in this context,as well as the advantages and disadvantages of MCFI and SCFI.Overall,MCFI represents a significant advancement in fluorescence-guided surgery,with the potential to become a standard imaging modality for safer and more effective laparoscopic procedures.
基金Supported by the National Natural Science Foundation of China,No.82473154 and No.82372805Jiangsu Province Basic Research Special Fund(Soft Science Research)Special Funding,No.BK20210022Nanjing Municipal Special Fund for Health Science and Technology Development,No.YKK21078.
文摘Gastric cancer(GC)ranks among the most common and deadly malignancies globally.Surgical resection with lymph node(LN)dissection is the primary treatment.The accuracy of LN dissection is essential to reduce postoperative complications and mortality.Therefore,improving the quality of LN dissection in GC surgery and refining postoperative LN staging have been the focus of clinical attention.Indocyanine green(ICG)fluorescence imaging serves as a vital clinical tracing technique in GC surgery.It enables accurate tumor localization,enhances the completeness of LN dissection,and evaluates anastomotic blood supply after digestive tract reconstruction.These benefits collectively improve surgical outcomes and lower recurrence rates.This article examines the principles of ICG fluorescence imaging and its necessity in GC tracing surgery.Compared to conventional tracers,ICG offers superior safety and lower toxicity,with robust evidence supporting its clinical efficacy.This technology represents a paradigm shift in GC surgery.Current studies optimize ICG delivery protocols,such as injection time and dose,and integrate it with emerging technologies like robotic systems to improve LN detection rates.This article demonstrates the safety and efficacy of ICG as a tracer,which is poised to advance the precision of GC surgery and improve patient outcomes.
基金Supported by Fujian Provincial Health and Youth Research Project,No.2022QNA066the Key Clinical Specialty Discipline Construction Program of Fujian,Fujian Health Medicine and Politics,No.[2022]884.
文摘Indocyanine green fluorescence imaging technology has been increasingly utilized in rectal surgery in recent years.As a safe tracer,indocyanine green can facilitate lymph node tracing,assess the blood supply at anastomotic sites,and localize tumour lesions during laparoscopic surgery,thereby resulting in favourable outcomes.This technology helps surgeons to achieve more precise diagnoses and treatments in laparoscopic procedures,thus ultimately benefiting patients.However,the current application of indocyanine green fluorescence imaging technology still lacks standardized regulations,and certain effects remain contentious.This study provides a comprehensive review of the application of indocyanine green in laparoscopic surgery for rectal cancer based on the pertinent literature.
基金supported by Natural Science Foundation of Hubei Province(ZRMS2020002466 to Liu Z).
文摘Dear Editor,Radical cystectomy(RC)remains the standard treatment for muscle-invasive bladder cancer[1].However,urinary diversion after RC can lead to a range of postoperative complications,including parastomal hernia,incontinence,urinary retention,recurrent urinary tract infections,and metabolic disorders,significantly impacting patients'quality of life[2].Partial cystectomy(PC)is a bladdersparing alternative for patients who cannot accept RC and has been utilized in managing muscle-invasive bladder cancer since the last century.However,the application of PC has always been a subject of controversy in clinical practice due to the high recurrence rate.In a matched case-control analysis conducted by Knoedler et al.[3],38%of the patients experienced intravesical tumor recurrence,and 19%of the patients ultimately underwent RC.Another study in the Memorial Sloan-Kettering Cancer Center showed that 22 of 58 patients who received PC experienced superficial or advanced recurrence[4].
基金Supported by the Incubation Project of Zhongshan Hospital(Xiamen),Fudan University,No.2019ZSXMYS15the Clinical Research Center for Precision Medicine of Abdominal Tumor of Fujian Province+1 种基金the Key Clinical Specialty Discipline Construction Program of Fujian ProvinceXiamen Medical and Health Guidance Project,No.3502Z20244ZD1103.
文摘BACKGROUND Improving the intraoperative and postoperative performance of laparoscopic hepatectomy was quite a challenge for liver surgeons.AIM To determine the benefits of indocyanine green(ICG)fluorescence imaging in patients with hepatocellular carcinoma(HCC)who underwent laparoscopic hepatectomy during and after surgery.METHODS We retrospectively collected the clinicopathological data of 107 patients who successfully underwent laparoscopic hepatectomy at Zhongshan Hospital(Xiamen),Fudan University from June 2022 to June 2023.Whether using the ICG fluorescence imaging technique,we divided them into the ICG and non-ICG groups.To eliminate statistical bias,a 1:1 propensity score matching analysis was conducted.The comparison of perioperative outcomes,including inflammationrelated markers and progression-free survival,was analyzed statistically.RESULTS Intraoperatively,the ICG group exhibited lower blood loss,a shorter surgical time,lower hepatic inflow occlusion(HIO)frequency,and a shorter total HIO time.Postoperatively,the participation of ICG resulted in a shorter duration of hospitalization(6.5 vs 7.6 days,P=0.03)and postoperative inflammatory response attenuation(lower neutrophil-lymphocyte ratio on the first day after surgery and platelet-lymphocyte ratio on the third day,P<0.05).Although the differences were not significant,the levels of all inflammation-related markers were lower in the ICG group.The rates of postoperative complications and the survival analyses,including progression-free and overall survivals showed no significant difference between the groups.CONCLUSION The involvement of ICG fluorescence imaging may lead to improved perioperative outcomes,especially postoperative inflammatory response attenuation,and ultimately improve HCC patients’recovery after surgery.
文摘BACKGROUND Intraoperative and postoperative biliary injuries remain significant complications of laparoscopic common bile duct exploration(LCBDE).Indocyanine green(ICG)has been shown to significantly reduce injuries caused by intraoperative operational errors.We found that the J-tube can reduce postoperative strictures and injuries to the common bile duct.At this moment,we aim to analyze and compare the complications,efficacy,short-term outcomes,and feasibility of these two adjunctive tools for LCBDE.AIM To evaluate the efficacy of ICG fluorescence imaging In LCBDE and J-tube drainage for patients with common bile duct stones.METHODS We retrospectively collected the clinical case data of patients who were treated at the Hepatobiliary Surgery Department of the Third People’s Hospital of Nantong,affiliated with Nantong University,from January 2016 to January 2021 due to gallbladder stones with choledocholithiasis and who underwent LCBDE combined with a primary suture and either J-tube or T-tube drainage.The patients were divided into groups:Traditional white-light laparoscopy+T-tube group(WL+T-tube),traditional WL+J-tube group,fluorescent laparoscopy+T-tube group(ICG+T-tube)and fluorescent laparoscopy+J-tube group(ICG+J-tube).The preoperative and postoperative clinical case data,laboratory examination data,and intraoperative and postoperative complications(including postoperative bile leakage,electrolyte disturbances,biliary peritonitis,and postoperative infections)and other relevant indicators were compared.RESULTS A total of 198 patients(112 males and 86 females)were included in the study,with 74 patients in the WL+T-tube,47 in the WL+J-tube,42 in the ICG+T-tube,and 35 in the ICG+J-tube.Compared with the other groups,the ICG+J had significantly shorter operation time(114 minutes,P=0.001),less blood loss(42 mL,P=0.02),shorter postoperative hospital stays(7 days,P=0.038),and lower surgical costs(China yuan 30178,P=0.001).Furthermore,patients were subdivided into two groups based on whether a T-tube or J-tube was placed during the surgery.By the third postoperative day,the aspartate transaminase,glutamic pyruvic transaminase,total bilirubin,and direct bilirubin levels were lower in the J-tube group than in the T-tube group(P<0.001).At last,follow-up observations showed that the incidence of biliary strictures at three months postoperatively was significantly lower in the J-tube group than in the T-tube group(P=0.002).CONCLUSION ICG fluorescence imaging in laparoscopic cholecystectomy with common bile duct exploration and J-tube drainage facilitates rapid identification of biliary anatomy and variations,reducing intraoperative bile duct injury,blood loss,surgery duration,and postoperative bile duct stenosis rates,supporting its clinical adoption.
文摘To the Editor:Laparoscopic liver resection(LLR)is widely used as a standard procedure for liver malignancies and benign diseases.Consensus guidelines stated that LLR may be feasible and safe in experienced centers.Evidence has shown that LLR is less invasive and has bet-ter patient prognosis than conventional procedures[1].However,laparoscopic anatomic liver resection(LALR)such as segment 8(S8)resection is still challenging due to difficulties in segmental mapping and surgical techniques[2,3].Liver S8 is in a deep-seated area surrounded by the ribs and the diaphragm,and closely con-nected to the right and middle hepatic veins and inferior vena cava.Furthermore,the Glissonean pedicle of segment 8(G8)is lo-cated deep in the liver parenchyma,lacking anatomical landmarks,and making forceps manipulation difficult.Therefore,LALR-S8 has been described as the most challenging procedure[4].
基金supported by National Natural Science Foundation of China (Nos. 22277070, 22274091, 22007061)Youth Talent Support Program of Shanxi Province+1 种基金Program for the Top Young Academic Leaders of Higher Learning Institutions of ShanxiFundamental Research Program of Shanxi Province (No. 20210302123445)。
文摘In this work, we put forward a new and universal approach, i.e., cyanine ketone method, for fabricating meso–aryl heptamethine indocyanines, which is so simple that the treatment of the easy-to-get cyanine ketones with various aromatic lithium(Ar Li), followed by acidification, could straightforwardly give rise to the products in one-pot way. Importantly, due to the strong nucleophilicity of Ar Li, a series of bulky hydrophilic aromatic groups can be facilely integrated into the meso–position of heptamethine indocyanines, not only effectively inhibiting the undesired dye self-aggregation but also largely improving the water-solubility. Using one of anti-aggregation meso–aryl heptamethine indocyanines, we fabricated a dye-antibody conjugate for in vivo imaging tumor in a mouse model and achieved a high tumor-tonormal tissue ratio. The work laid a chemical foundation for constructing various meso–aryl heptamethine indocyanines, facilitating the advanced imaging and therapeutic applications in future.
文摘Laparoscopic cholecystectomy(LC)remains one of the most commonly performed procedures in adult and paediatric populations.Despite the advances made in intraoperative biliary anatomy recognition,iatrogenic bile duct injuries during LC represent a fatal complication and consist an economic burden for healthcare systems.A series of methods have been proposed to prevent bile duct injury,among them the use of indocyanine green(ICG)fluorescence.The most commonly reported method of ICG injection is the intravenous administration,while literature is lacking studies investigating the direct intragallbladder ICG injection.This narrative mini-review aims to assess the potential applications,usefulness,and limitations of intragallbladder ICG fluorescence in LC.Authors screened the available international literature to identify the reports of intragallbladder ICG fluorescence imaging in minimally invasive cholecystectomy,as well as special issues regarding its use.Literature search retrieved four prospective cohort studies,three case-control studies,and one case report.In the three case-control studies selected,intragallbladder near-infrared cholangiography(NIRC)was compared with standard LC under white light,with intravenous administration of ICG for NIRC and with standard intraoperative cholangiography(IOC).In total,133 patients reported in the literature have been administered intragallbladder ICG administration for biliary mapping during LC.Literature includes several reports of intragallbladder ICG administration,but a standardized technique has not been established yet.Published data suggest that NIRC with intragallbladder ICG injection is a promising method to achieve biliary mapping,overwhelming limitations of IOC including intervention and radiation exposure,as well as the high hepatic parenchyma signal and time interval needed in intravenous ICG fluorescence.Evidence-based guidelines on the role of intragallbladder ICG fluorescence in LC require the assessment of further studies and multicenter data collection into large registries.
文摘BACKGROUND Preoperative evaluation of future remnant liver reserves is important for safe hepatectomy.If the remnant is small,preoperative portal vein embolization(PVE)is useful.Liver volume analysis has been the primary method of preoperative evaluation,although functional examination may be more accurate.We have used the functional evaluation liver using the indocyanine green plasma clearance rate(KICG)and 99mTc-galactosyl human serum albumin single-photon emission computed tomography(99mTc-GSA SPECT)for safe hepatectomy.AIM To analyze the safety of our institution’s system for evaluating the remnant liver reserve.METHODS We retrospectively reviewed the records of 23 patients who underwent preoperative PVE.Two types of remnant liver KICG were defined as follows:Anatomical volume remnant KICG(a-rem-KICG),determined as the remnant liver anatomical volume rate×KICG;and functional volume remnant KICG(frem-KICG),determined as the remnant liver functional volume rate based on 99mTc-GSA SPECT×KICG.If either of the remnant liver KICGs were>0.05,a hepatectomy was performed.Perioperative factors were analyzed.We defined the marginal group as patients with a-rem-KICG of<0.05 and a f-rem-KICG of>0.05 and compared the postoperative outcomes between the marginal and not marginal(both a-rem-KICG and f-rem-KICG>0.05)groups.RESULTS All 23 patients underwent planned hepatectomies.Right hepatectomy,right trisectionectomy and left trisectionectomy were in 16,6 and 1 cases,respectively.The mean of blood loss and operative time were 576 mL and 474 min,respectively.The increased amount of frem-KICG was significantly larger than that of a-rem-KICG after PVE(0.034 vs 0.012,P=0.0273).The not marginal and marginal groups had 17(73.9%)and 6(26.1%)patients,respectively.The complications of Clavian-Dindo classification grade II or higher and post-hepatectomy liver failure were observed in six(26.1%)and one(grade A,4.3%)patient,respectively.The 90-d mortality was zero.The marginal group had no significant difference in postoperative outcomes(prothrombin time/international normalised ratio,total bilirubin,complication,post-hepatectomy liver failure,hospital stay,90-d,and mortality)compared with the not-marginal group.CONCLUSION Functional evaluation of the remnant liver enabled safe hepatectomy and may extend the indication for hepatectomy after PVE treatment.
文摘In recent years,the use of fluorescence-guided surgery(FGS)to treat benign and malignant visceral,hepatobiliary and pancreatic neoplasms has significantly increased.FGS relies on the fluorescence signal emitted by injected substances(fluorophores)after being illuminated by ad hoc laser sources to help guide the surgical procedure and provide the surgeon with real-time visualization of the fluorescent structures of interest that would be otherwise invisible.This review surveys and discusses the most common and emerging clinical applications of indocyanine green(ICG)-based fluorescence in visceral,hepatobiliary and pancreatic surgery.The analysis,findings,and discussion presented here rely on the authors'significant experience with this technique in their medical institutions,an up-to-date review of the most relevant articles published on this topic between 2014 and 2018,and lengthy discussions with key opinion leaders in the field during recent conferences and congresses.For each application,the benefits and limitations of this technique,as well as applicable future directions,are described.The imaging of fluorescence emitted by ICG is a simple,fast,relatively inexpensive,and harmless tool with numerous different applications in surgery for both neoplasms and benign pathologies of the visceral and hepatobiliary systems.The ever-increasing availability of visual systems that can utilize this tool will transform some of these applications into the standard of care in the near future.Further studies are needed to evaluate the strengths and weaknesses of each application of ICG-based fluorescence imaging in abdominal surgery.
文摘BACKGROUND: The indocyanine green (ICG) clearance test (clearance rate (K) and retention rate at 15 minutes (R(15))) is a sensitive indicator to evaluate liver function. The model for end-stage liver disease (MELD) score has emerged as a useful tool for estimating the mortality of patients awaiting liver transplantation and has recently been validated on patients with liver diseases of various etiologies and severity. In this study, we investigated the correlation between the ICG clearance test and MELD score of patients with liver cirrhosis. METHODS: From June 2007 to March 2008, 52 patients with liver cirrhosis admitted to our center were classified into Child-Pugh class A (8 patients), B (14) and C (30). The ICG clearance test (K value and R(15)) was performed by ICG pulse spectrophotometry (DDG-3300K), and the MELD scores of patients were calculated. RESULTS: As the Child-Pugh classification of liver function gradually deteriorated, the K value decreased, while R(15) and MELD score increased. There were significant statistical differences in K value, R(15) and MELD score in patients with different Child-Pugh classifications. Significant correlations were found between the parameters of the ICG clearance test (K value and R(15)) and MELD score. A negative correlation was observed between K value and MELD score (r=-0.892, P < 0.05), while a positive correlation was observed between R(15) and MELD score (r=0.804, P < 0.05). CONCLUSIONS: The ICG clearance test and MELD score are good parameters for evaluating liver function. Moreover, K value and R(15) have significant correlations with MELD score, especially the K value, which may be a convenient and appropriate indicator to evaluate liver function of patients with liver cirrhosis.
基金supported by a grant from the Foundation of the Ministry of Health,China(2008ZX1005)
文摘BACKGROUND: Acute liver failure(ALF) is an acute severe deterioration of liver function with high mortality. Early and accurate prognostic assessment of patients with ALF is critically important. Although the model for end-stage liver disease(MELD) scores and King’s College Hospital(KCH) criteria are well-accepted as predictive tools, their accuracy is unsatisfactory.The indocyanine green(ICG) clearance test(ICGR15, ICG retention rate at the 15 minutes) is a sensitive indicator of liver function. In this study, we investigated the efficacy of the ICGR15 for the short-term prognosis in patients with ALF. We compared the predictive value of ICGR15 with the MELD scores and KCH criteria.METHODS: Sixty-nine patients who had been diagnosed with ALF were recruited retrospectively. ICGR15 had been performed by ICG pulse spectrophotometry and relevant clinical and laboratory indices were analyzed within 24 hours of diagnosis.In addition, the MELD scores and KCH criteria were calculated.RESULTS: The three-month mortality of all patients was 47.83%.Age, serum total bilirubin and creatinine concentrations,international normalized ratio for prothrombin time, ICGR15,MELD scores and KCH criteria differed significantly between surviving and deceased patients. A positive correlation was observed between ICGR15 and MELD scores(r=0.328, P=0.006).The ICGR15-MELD model, Logit(P)=0.096×ICGR15+0.174 ×MELD score–9.346, was constructed by logistic regression analysis. The area under the receiver operating characteristic curve was 0.855. When set the cut-off point to-0.4684, the sensitivity was 87.90% and specificity, 72.20%. The area under the receiver operating characteristic curve of the ICGR15-MELD model(0.855) was significantly higher than that of the ICGR15(0.793), MELD scores(0.776) and KCH criteria(0.659).Based on this cut-off value, the patients were divided into two groups. The mortality was 74.36% in the first group(ICGR15-MELD≥-0.4686) and 13.33% in the second group(ICGR15-MELD<-0.4686), with a significant difference between the two groups(χ2=25.307, P=0.000).CONCLUSION: The ICGR15-MELD model is superior to the ICGR15, MELD scores, and KCH criteria in predicting the shortterm prognosis of patients with ALF.
基金supported by grants from the Clinical Research Founding of Southwest Hospital (Grant No. SWH2016BZGFKJ-30), Technological Innovation for Intelligent Medicine of Southwest Hospital (Grant No. SWH2016ZDCX4403) Talents Training Program of Third Military Medical University (Grant No. 2017MPRC18)
文摘Objective:This randomized study aimed to compare the clinical efficacy between the novel dual tracer composed of indocyanine green(ICG)and blue dye(BD)and the conventional dual tracer composed of radioisotope and BD for sentinel lymph node(SLN)mapping in patients with breast cancer.Methods:This study enrolled 471 clinically lymph node-negative patients with primary breast cancer.All patients underwent mastectomy,and those undergoing sentinel lymph node biopsy(SLNB)were randomized to receive blue dye plus radioisotope(RB group)or BD plus ICG(IB group).The detection performances on SLN identification rate,positive SLN counts,detection sensitivity,and false-negative rate were compared between the two groups.Results:In the IB group,97%(194/200)of the patients who underwent the ICG and BD dual tracer injection showed fluorescentpositive lymphatic vessels within 2–5 min.The identification rate of SLNs was comparable between the IB group(99.0%,198/200)and the RB group(99.6%,270/271)(P=0.79).No significant differences were observed in the identification rate of metastatic SLNs(22.5%vs.22.9%,P>0.05,RB group vs.IB group,the same below),positive SLN counts(3.72±2.28 vs.3.91±2.13,P>0.05),positive metastatic SLN counts(0.38±0.84 vs.0.34±0.78,P>0.05),SLNB detection sensitivity(94.4%vs.92.5%,P>0.05),or false-negative rate(5.6%vs.7.5%,P>0.05)between the two groups.Conclusions:ICG can be used as a promising alternative tracer for radioisotope in SLN mapping,and when it is combined with BD in lymphangiography,it offers comparable detection sensitivity compared to the conventional lymphatic mapping strategies that are widely used in clinical practice.
文摘Indocyanine green(ICG) kinetics(PDR/R15) used to quantitatively assess hepatic function in the perioperative period of major resective surgery and liver transplantation have been the object of an extensive, updated and critical review. New, non invasive bedside monitors(pulse dye densitometry technology) make this opportunity widely available in clinical practice. After having reviewed basic concepts of hepatic clearance, we analysed the most common indications ICG kinetic parameters have nowadays in clinical practice, focusing in particular on the diagnostic and prognostic role of PDR and R15 in the perioperative period of major liver surgery and liver transplantation. As recently pointed out, even if of extreme interest, ICG clearance parameters have still some limitations, to be considered when using these tests.
文摘BACKGROUND As one effective treatment for lateral pelvic lymph node(LPLN)metastasis(LPNM),laparoscopic LPLN dissection(LPND)is limited due to the complicated anatomy of the pelvic sidewall and various complications after surgery.With regard to improving the accuracy and completeness of LPND as well as safety,we tried an innovative method using indocyanine green(ICG)visualized with a near-infrared(NIR)camera system to guide the detection of LPLNs in patients with middle-low rectal cancer.AIM To investigate whether ICG-enhanced NIR fluorescence-guided imaging is a better technique for LPND in patients with rectal cancer.METHODS A total of 42 middle-low rectal cancer patients with clinical LPNM who underwent total mesorectal excision(TME)and LPND between October 2017 and March 2019 at our institution were assessed and divided into an ICG group and a non-ICG group.Clinical characteristics,operative outcomes,pathological outcomes,and postoperative complication information were compared and analysed between the two groups.RESULTS Compared to the non-ICG group,the ICG group had significantly lower intraoperative blood loss(55.8±37.5 mL vs 108.0±52.7 mL,P=0.003)and a significantly larger number of LPLNs harvested(11.5±5.9 vs 7.1±4.8,P=0.017).The LPLNs of two patients in the non-IVG group were residual during LPND.In addition,no significant difference was found in terms of LPND,LPNM,operative time,conversion to laparotomy,preoperative complication,or hospital stay(P>0.05).CONCLUSION ICG-enhanced NIR fluorescence-guided imaging could be a feasible and convenient technique to guide LPND because it could bring specific advantages regarding the accuracy and completeness of surgery as well as safety.
基金Supported by a Grant-in-Aid for Scientific Research(C)from the Ministry of Education,Culture,Sports,Science,and Technology,Japan,No.17K10460(to Aung W)
文摘AIM To investigate near-infrared photoimmunotherapeutic effect mediated by an anti-tissue factor(TF) antibody conjugated to indocyanine green(ICG) in a pancreatic cancer model.METHODS Near-infrared photoimmunotherapy(NIR-PIT) is a highly selective tumor treatment that utilizes an antibody-photosensitizer conjugate administration, followed by NIR light exposure. Anti-TF antibody 1849-ICG conjugate was synthesized by labeling of rat IgG2 b anti-TF monoclonal antibody 1849(anti-TF 1849) to a NIR photosensitizer,ICG. The expression levels of TF in two human pancreatic cancer cell lines were examined by western blotting. Specific binding of the 1849-ICG to TF-expressing BxPC-3 cells was examined by fluorescence microscopy. NIR-PITinduced cell death was determined by cell viability imaging assay. In vivo longitudinal fluorescence imaging was used to explore the accumulation of 1849-ICG conjugate in xenograft tumors. To examine the effect of NIRPIT, tumor-bearing mice were separated into 5 groups:(1) 100 μg of 1849-ICG i.v. administration followed by NIR light exposure(50 J/cm2) on two consecutive days(Days 1 and 2);(2) NIR light exposure(50 J/cm2) only on two consecutive days(Days 1 and 2);(3) 100 μg of 1849-ICG i.v. administration;(4) 100 μg of unlabeled antiTF 1849 i.v. administration; and(5) the untreated control. Semiweekly tumor volume measurements, accompanied with histological and immunohistochemical(IHC) analyses of tumors, were performed 3 d after the 2nd irradiation with NIR light to monitor the effect of treatments. RESULTS High TF expression in BxPC-3 cells was observed via western blot analysis, concordant with the observed preferential binding with intracellular localization of 1849-ICG via fluorescence microscopy. NIR-PIT-induced cell death was observed by performing cell viability imaging assay. In contrast to the other test groups, tumor growth was significantly inhibited by NIR-PIT with a statistically significant difference in relative tumor volumes for 27 d after the treatment start date [2.83 ± 0.38(NIR-PIT) vs 5.42 ± 1.61(Untreated), vs 4.90 ± 0.87(NIR), vs 4.28 ±1.87(1849-ICG), vs 4.35 ± 1.42(anti-TF 1849), at Day 27, P < 0.05]. Tumors that received NIR-PIT showed evidence of necrotic cell death-associated features upon hematoxylin-eosin staining accompanied by a decrease in Ki-67-positive cells(a cell proliferation marker) by IHC examination.CONCLUSION The TF-targeted NIR-PIT with the 1849-ICG conjugate can potentially open a new platform for treatment of TF-expressing pancreatic cancer.
