A prospective study evaluating fluorescence guided minimally invasive
paediatric solid tumour surgery using indocyanine green.
Abstract
Background Indocyanine green (ICG) fluoresces in the near infra-red
(NIR) spectrum. It is widely used in adult oncological surgery for
identification of tumor margins and lymph node sampling. However, its
use in the pediatric population is limited. This is the first study in
children to assess its feasibility in minimally invasive surgery (MIS)
for oncological disease Methods This was an open label, prospective,
single centre, feasibility study recruiting consecutive patients
eligible for MIS tumor resection. ICG was injected intravenously at
induction of anaesthesia and/or intra-parenchymally for patients having
tumor nephrectomy. Patient demographics, intraoperative appearances,
nodal fluorescence, post-operative histopathology, and surgeon Likert
ratings were collected. Results Seventeen patients conformed to the
inclusion criteria. Five had a Wilms tumor, 4 had lung metastases and 8
had other tumors (neuroblastoma, inflammatory myofibroblastic tumor,
ganglioneuroma, phaeochromocytoma, adrenal tumor). For those having
lymph node sampling, a median of 8(3-9) nodes were sampled. Lung
metastases were easily identifiable, and all had negative margins.
Tumors containing viable disease fluoresced and were completely
resected, whilst benign and heavily treated tumors were afluorescent.
There were no adverse events relating to ICG. Conclusion Based on this
small sample, injection of ICG during induction of anaesthesia is safe
and effective in showing tumor margins in patients who have had little
or no neoadjuvant chemotherapy as well as in metastectomy in Wilms and
osteosarcoma. Its use in renal tumor resection results in adequate nodal
sampling. Further studies are needed to confirm these preliminary
results.