Fluorescence-Guided Surgery with Indocyanine Green for Hepatoblastoma in a Child - Abstract
Purpose: Complete resection of the primary lesion and lung metastases is important for the treatment of hepatoblastoma in children. Surgical navigation using Indocyanine green (ICG) is effective in identifying micro-lung metastatic lesions. Method: We examined eight procedures performed on six cases of hepatoblastoma lung metastases. In all cases, ICG (0.5 mg/kg) was intravenously administered 24 hours before surgery to identify the lesion. Results: Our cases included five males and one female, and the age at surgery ranged from 6 months to 12 years, and the affected side was the right side for five cases, the left side for one case, and both sides (including recurrent surgery) for two cases. The number of excised specimens was 34. Of those, 23 had tumor cells and 33 were ICG-positive. Of the 33 specimens, 23 were ICG-positive and had tumor cells, while 10 specimens were ICG-positive with no tumor cells. In addition, 18 out of 34 specimens were positive on preoperative computed tomography, and tumor cells were observed in all of them. There were 16 specimens that were negative on computed tomography but positive for ICG, of which six specimens showed tumor cells. Conclusion: Fluorescence-guided surgery is useful for visualizing micro-lung metastases that cannot be detected by imaging modalities. However, there are some false positives. Therefore, it is necessary to develop a technique for recognizing true micro-lung metastases.