title: Intraoperative Near-Infrared Fluorescence Imaging using indocyanine green in colorectal carcinomatosis surgery: Proof of concept.
abstract: OBJECTIVE
  This study assesses the value of using Intraoperative Near Infrared Fluorescence Imaging and Indocyanine green to detect colorectal carcinomatosis during oncological surgery. In colorectal carcinomatosis cancer, two of the most important prognostic factors are completeness of staging and completeness of cytoreductive surgery. Presently, intraoperative assessment of tumoral margins relies on palpation and visual inspection. The recent introduction of Near Infrared fluorescence image guidance provides new opportunities for surgical roles, particularly in cancer surgery.
  
  
  METHODS
  The study was a non-randomized, monocentric, pilot "ex vivo" blinded clinical trial validated by the ethical committee of University Hospital of Saint Etienne. Ten patients with colorectal carcinomatosis cancer scheduled for cytoreductive surgery were included. Patients received 0.25 mg/kg of Indocyanine green intravenously 24 h before surgery. A Near Infrared camera was used to detect "ex-vivo" fluorescent lesions.
  
  
  RESULTS
  There was no surgical mortality. Each analysis was done blindly. In a total of 88 lesions analyzed, 58 were classified by a pathologist as cancerous and 30 as non-cancerous. Among the 58 cancerous lesions, 42 were correctly classified by the Intraoperative Near-Infrared camera (sensitivity of 72.4%). Among the 30 non-cancerous lesions, 18 were correctly classified by the Intraoperative Near-Infrared camera (specificity of 60.0%).
  
  
  CONCLUSIONS
  Near Infrared fluorescence imaging is a promising technique for intraoperative tumor identification. It could help the surgeon to determine resection margins and reduce the risk of locoregional recurrence.
authors.affiliation: Université Jean Monnet, LINA EA 4624, 42023 Saint Etienne, France; Oncological and Digestive Surgery, Saint Etienne University Hospital, 42000 Saint Etienne, France; INSERM-UJF U823, Institut Albert Bonniot, 38706 Grenoble, France. Electronic address: g.barabino77@gmail.com.
authors.forename: G
authors.initials: G
authors.lastname: Barabino
authors.affiliation: Université Jean Monnet, LINA EA 4624, 42023 Saint Etienne, France.
authors.forename: J P
authors.initials: JP
authors.lastname: Klein
authors.affiliation: Oncological and Digestive Surgery, Saint Etienne University Hospital, 42000 Saint Etienne, France.
authors.forename: J
authors.initials: J
authors.lastname: Porcheron
authors.affiliation: INSERM-UJF U823, Institut Albert Bonniot, 38706 Grenoble, France.
authors.forename: A
authors.initials: A
authors.lastname: Grichine
authors.affiliation: INSERM-UJF U823, Institut Albert Bonniot, 38706 Grenoble, France.
authors.forename: J-L
authors.initials: JL
authors.lastname: Coll
authors.affiliation: Université Jean Monnet, LINA EA 4624, 42023 Saint Etienne, France.
authors.forename: M
authors.initials: M
authors.lastname: Cottier
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D000068258:Bevacizumab / Q000627:therapeutic use; D002277:Carcinoma / Q000000981:diagnostic imaging* / Q000628:therapy; D000068818:Cetuximab / Q000627:therapeutic use; D059186:Chemoradiotherapy, Adjuvant; D017024:Chemotherapy, Adjuvant; D015179:Colorectal Neoplasms / Q000473:pathology*; D004396:Coloring Agents; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced; D007208:Indocyanine Green; D007263:Infusions, Parenteral; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D061848:Optical Imaging / Q000379:methods*; D010534:Peritoneal Neoplasms / Q000000981:diagnostic imaging* / Q000628:therapy; D010537:Peritoneum / Q000000981:diagnostic imaging* / Q000601:surgery; D010865:Pilot Projects
chemical_list: D000970:Antineoplastic Agents; D004396:Coloring Agents; D000068258:Bevacizumab; D007208:Indocyanine Green; D000068818:Cetuximab
keywords: Colorectal peritoneal carcinomatosis; Indocyanine green; Intraoperative Near-Infrared Imaging Fluorescence System; Surgery