Near-infrared fluorescence-guided metastasectomy for hepatic gastrointestinal stromal tumor metastases using indocyanine green: A case report

•Near-infrared fluorescence imaging should be considered as an additional imaging technique to intraoperative ultrasound during surgery for hepatic metastasis.•Near-infrared fluorescence imaging can aid surgeons in the identification of preoperatively identified liver metastases from primary GIST.•F...

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Bibliographic Details
Published in:International journal of surgery case reports 2021-01, Vol.78, p.250-253
Main Authors: Bijlstra, O.D., Achterberg, F.B., Tummers, Q.R.J.G., Mieog, J.S.D., Hartgrink, H.H., Vahrmeijer, A.L.
Format: Article
Language:English
Subjects:
Case Report
Gastrointestinal stromal tumor
Indocyanine green
Liver metastases
Near-infrared fluorescence-guided surgery
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Summary:•Near-infrared fluorescence imaging should be considered as an additional imaging technique to intraoperative ultrasound during surgery for hepatic metastasis.•Near-infrared fluorescence imaging can aid surgeons in the identification of preoperatively identified liver metastases from primary GIST.•For the detection of additional superficially located liver metastases from primary GIST near-infrared fluorescence imaging can be used.•Real-time evaluation of resection margins with NIRF imaging may lead to a lower number of R1 resections. Gastrointestinal stromal tumors are the most prevalent mesenchymal tumors of the gastrointestinal tract. Distant metastases are most often found in the liver or peritoneum with surgery being the preferred treatment option. In our center, fluorescence-guided surgery with indocyanine green is used as standard-of-care for hepatic metastases in colorectal cancer. This case report describes fluorescence-guided metastasectomy for a hepatic gastrointestinal stromal tumor in two patients undergoing open liver resection and radiofrequency ablation. A 69-year old women was seen during follow-up after laparoscopic resection of a GIST in the lesser curvature of the stomach. Contrast-enhanced computed tomography imaging showed two suspicious lesions in liver segment VI and VIII. Intraoperative near-infrared fluorescence imaging of the liver clearly revealed the lesion in segment VIII, and an additional lesion in segment V – which was not seen on preoperative CT-imaging, neither on intraoperative ultrasonography. The lesion in segment VI was not seen with NIRF imaging due to its deeper location in the liver parenchyma. The second case is an 82-year old man who was also diagnosed with liver metastases from a GIST in the stomach and was scheduled for near-infrared fluorescence-guided liver resection and radio frequency ablation. In this case report we demonstrated the feasibility of fluorescence-guided surgery in detection of liver metastases and treatment planning of two patients with hepatic GIST metastases using indocyanine green. NIRF-imaging with ICG is useful for identification of preoperatively discovered lesions, surgical resection planning and margin evaluation, and for detection of additional hepatic GIST metastases.
ISSN:2210-2612
2210-2612
DOI:10.1016/j.ijscr.2020.12.058