title: Is there a role for near-infrared technology in laparoscopic resection of pancreatic neuroendocrine tumors? Results of the COLPAN "colour-and-resect the pancreas" study.
abstract: The intraoperative identification of pancreatic neuroendocrine tumors (PanNETs) is of utmost importance to drive their laparoscopic resection. Near-infrared (NIR) surgery has emerged as a new technique for localizing tumors or neoplastic tissue. This study aimed to explore the results of the application of NIR in the laparoscopic resection of PanNETs.
  
  
  
  Per protocol we enrolled ten subjects undergoing laparoscopic pancreatic surgery for PanNET from March 2016 to October 2016. During surgery, the patients were injected with indocyanine green dye (ICG, 25 mg given in 5 boli of 5 mg each). The switch-activation of NIR was performed to identify PanNETs. An ex-post analysis of the images was realized using ImageJ Software® to calculate the fluorescence signal.
  
  
  
  NIR imaging identified all ten PanNETs. Nine (90%) laparoscopic distal pancreatectomy with splenectomy and one (10%) laparoscopic enucleation were performed. The mean maximum tumor dimension was 2.4 cm (range 1-4 cm). Eight non-functioning PanNETs (80%) and two insulinomas (20%) were found at the final pathology. Nine out of ten (90%) PanNETs were detected after the second ICG bolus. The mean latency time was 80 s and the mean visibility time was 220 s. The peak of tumor visualization was reached 20 min after the last bolus. This finding was confirmed by the ex-post analysis of the fluorescence signal (mean signal-to-background ratio of 7.7, p = 0.001). NIR identified two additional lesions, which turned out to be normal lymph nodes at final pathology. A fluorescent signal was identified at the bed of the enucleation, and thus, a further exeresis was performed and final pathology revealed that is was residual neoplastic tissue.
  
  
  
  This explorative study shows that NIR with ICG can have a role in laparoscopic pancreatic resection of PanNETs. Further studies are needed to assess the proper setting and role of this new and promising technology.
authors.affiliation: General and Pancreatic Surgery Department, Pancreas Institute, University and Hospital Trust of Verona, Policlinico GB Rossi, Piazzale L.A. Scuro, 10, 37134, Verona, Italy. salvatore.paiella@univr.it.
authors.forename: Salvatore
authors.identifier: 0000-0001-6893-8618
authors.initials: S
authors.lastname: Paiella
authors.affiliation: General and Pancreatic Surgery Department, Pancreas Institute, University and Hospital Trust of Verona, Policlinico GB Rossi, Piazzale L.A. Scuro, 10, 37134, Verona, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: De Pastena
authors.affiliation: General and Pancreatic Surgery Department, Pancreas Institute, University and Hospital Trust of Verona, Policlinico GB Rossi, Piazzale L.A. Scuro, 10, 37134, Verona, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Landoni
authors.affiliation: General and Pancreatic Surgery Department, Pancreas Institute, University and Hospital Trust of Verona, Policlinico GB Rossi, Piazzale L.A. Scuro, 10, 37134, Verona, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Esposito
authors.affiliation: General and Pancreatic Surgery Department, Pancreas Institute, University and Hospital Trust of Verona, Policlinico GB Rossi, Piazzale L.A. Scuro, 10, 37134, Verona, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Casetti
authors.affiliation: General and Pancreatic Surgery Department, Pancreas Institute, University and Hospital Trust of Verona, Policlinico GB Rossi, Piazzale L.A. Scuro, 10, 37134, Verona, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Miotto
authors.affiliation: General and Pancreatic Surgery Department, Pancreas Institute, University and Hospital Trust of Verona, Policlinico GB Rossi, Piazzale L.A. Scuro, 10, 37134, Verona, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Ramera
authors.affiliation: General and Pancreatic Surgery Department, Pancreas Institute, University and Hospital Trust of Verona, Policlinico GB Rossi, Piazzale L.A. Scuro, 10, 37134, Verona, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Salvia
authors.affiliation: General and Pancreatic Surgery Department, Pancreas Institute, University and Hospital Trust of Verona, Policlinico GB Rossi, Piazzale L.A. Scuro, 10, 37134, Verona, Italy.
authors.forename: Erica
authors.initials: E
authors.lastname: Secchettin
authors.affiliation: General and Pancreatic Surgery Department, Pancreas Institute, University and Hospital Trust of Verona, Policlinico GB Rossi, Piazzale L.A. Scuro, 10, 37134, Verona, Italy.
authors.forename: Deborah
authors.initials: D
authors.lastname: Bonamini
authors.affiliation: General and Pancreatic Surgery Department, Pancreas Institute, University and Hospital Trust of Verona, Policlinico GB Rossi, Piazzale L.A. Scuro, 10, 37134, Verona, Italy.
authors.forename: Gessica
authors.initials: G
authors.lastname: Manzini
authors.affiliation: Radiology Department, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy.
authors.forename: Mirko
authors.initials: M
authors.lastname: D'Onofrio
authors.affiliation: General and Pancreatic Surgery Department, Pancreas Institute, University and Hospital Trust of Verona, Policlinico GB Rossi, Piazzale L.A. Scuro, 10, 37134, Verona, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Marchegiani
authors.affiliation: General and Pancreatic Surgery Department, Pancreas Institute, University and Hospital Trust of Verona, Policlinico GB Rossi, Piazzale L.A. Scuro, 10, 37134, Verona, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Bassi
mesh_terms: D000328:Adult; D000368:Aged; D003116:Color; D004396:Coloring Agents; D005260:Female; D006801:Humans; D007208:Indocyanine Green; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000601:surgery*; D061848:Optical Imaging / Q000379:methods*; D010179:Pancreas / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D010180:Pancreatectomy / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green
keywords: Fluorescence-guided surgery; Indocyanine green; Laparoscopic pancreatic surgery; Near-infrared (NIR); Pancreatic neuroendocrine tumors