Optimizing Outcomes in Minimally Invasive Resections of Colorectal Liver Metastases
Mené sur 201 patients présentant des métastases hépatiques ayant pour origine un cancer colorectal (âge médian : 65 ans ; 57,7 % d'hommes), cet essai évalue la performance, du point de vue du taux de résection radicale R0 et de la précision de la détection des marges de résection positive, de l'imagerie par fluorescence au vert d'indocyanine dans le cadre d'une métastasectomie hépatique mini-invasive
The Minimally Invasive, Indocyanine-Guided Metastasectomy in Patients With Colorectal Liver Metastases (MIMIC) trial, a single-arm prospective multicenter cohort study conducted in 8 Dutch liver surgery centers, evaluated the accuracy of indocyanine green (ICG) in achieving margin-negative (R0) resections with minimally invasive resection colorectal liver metastasis (CRLM). Indocyanine green, 10 mg, was administered 24 hours prior to resection, and intraoperative ICG-fluorescence imaging was performed during and after parenchymal transection for real-time margin assessment. An R0 resection was defined as a distance of 1 mm or more between tumor and the resection margin. The final R0 resection rate was 92.4% in 201 patients included in the final analysis. This rate reflected an increase of 5.0% (from 87.4%) with re-resection of ICG-fluorescent tissue in the resection bed (P < .001). This modality of margin assessment reported a high specificity (90%) and negative predictive value (92%) with an acceptable sensitivity (60%) and positive predictive value (54%). Intraoperative surgical management changed in 27.9% of patients with use of ICG-fluorescence imaging.