Hepatic resection using intraoperative ultrasound and near-infrared imaging with indocyanine green fluorescence detects hepatic metastases from gastric cancer: A case report

INTRODUCTION AND IMPORTANCE: Near-infrared (NIR) imaging with indocyanine green (ICG) is a sensitive intraoperative tool for detecting liver tumors. NIR imaging has been used to distinguish metastatic liver cancer from colon cancer; however, its utility for identifying metastatic lesions from gastric cancer remains unknown. We present a case of advanced gastric cancer with multiple liver metastases, which was diagnosed and treated using intraoperative NIR imaging with ICG. CASE PRESENTATION: A 69-year-old man with advanced gastric cancer and simultaneous multiple liver metastases presented with gastric bleeding. He underwent gastrectomy and chemotherapy, which reduced the tumor burden. No new lesions were noted, and the patient was advised to undergo surgical resection of the residual liver metastases. Prior to surgery, 0.5 mg/kg of intravenous ICG was administered. NIR imaging was performed during hepatectomy, which revealed clear green fluorescence in several liver segments, indicating liver metastases. Two lesions were not identified during preoperative magnetic resonance imaging. All fluorescent areas were resected. The tumors identified by both preoperative and fluoresced intraoperatively demonstrated malignant features on histopathological examination. The two lesions that fluoresced intraoperatively but were not identified on preoperative images demonstrated normal liver parenchyma and no signs of malignancy. The patient remains tumor-free 1 year after surgery. CLINICAL DISCUSSION: This report demonstrates that hepatic metastases from gastric cancer can be diagnosed with intraoperative NIR imaging with ICG. CONCLUSIONS: NIR imaging with ICG can detect liver metastases but may provide false positive results. As the percentage of false positives is high, additional resections must be decided upon carefully.