Deploying Indocyanine Green Fluorescence-Guided Navigation System in Precise Laparoscopic Resection of Pediatric Hepatoblastoma

SIMPLE SUMMARY: Indocyanine green (ICG) is a safe reagent that has been clinically approved to assist in intraoperative navigations for the resection of hepatocellular carcinoma. Although an increasing trend has been observed in the use of an ICG fluorescence-guided system for hepatoblastoma (HB) surgery, studies involving a larger cohort of children is still lacking, which indicates a limitation in the application of ICG for pediatric HB surgery. Furthermore, there have also been few reports on its application in the field of laparoscopic surgery. Therefore, seven cases of HB resection were performed using the fluorescence-guided laparoscopic system in this study, and their clinical data were analyzed retrospectively to clarify the characteristics and outcomes of intraoperative ICG fluorescent imaging in laparoscopic HB resection among children. ABSTRACT: Background: Hepatoblastoma (HB) is the most common form of liver cancer in children. To date, complete tumor resection is still the gold standard for treating HB. Indocyanine green (ICG) has been identified as a sensitive adjunct that is highly effective in the identification and surgical management of local and metastatic HB. It has thus becomes an increasingly popular choice among surgeons in HB resection surgeries that are fluorescence-guided. However, laparotomy remains the preferred choice in most cases since the applications and limitations of fluorescence-guided laparoscopic surgery in treating HB remain unclear. In this study, the characteristics and outcomes of laparoscopic HB resections that were guided by intraoperative ICG fluorescent imaging were investigated. Methods: Seven HB patients underwent ICG-guided laparoscopic HB resection surgery from August 2019 to December 2021. ICG was intravenously administered to the patients at a dosage of 0.5 mg/kg 48 h prior to the scheduled operation. During operation, tumor localization and resection boundary were guided by fluorescence visualization. The data on surgical and clinical features were collected retrospectively. Results: The resection area and tumor boundary could be clearly viewed in real-time under the ICG fluorescence imaging navigation system during operation, except for one patient who had received interventional chemoembolization before surgery. The image produced by laparoscopic fluorescence navigation was clear since it was not affected by ambient light. All tumors were completely resected as confirmed by negative margins for HB during postoperative pathological examination. No residual or recurrence were also found through computed tomography during follow-up visits from 9 to 37 months. Conclusions: ICG fluorescence-guided laparoscopic surgery is safe and effective in treating HB due to its ability to provide clear information on tumor localization and delineate tumor margins in real-time.