Usefulness and limitation of indocyanine green fluorescence for detection of peritoneal recurrence after hepatectomy for hepatocellular carcinoma: a case report

Carbon Dots: From Synthesis to Unraveling the Fluorescence Mechanism

Carbon dots (CDs) being a new type of carbon-based nanomaterial have attracted intensive interest from researchers owing to their excellent biophysical properties. CDs are a class of fluorescent carbon nanomaterials that have emerged as a promising alternative to traditional quantum dots and organic dyes in applications including bioimaging, sensing, and optoelectronics. CDs possess unique optical properties, such as tunable emission, facile synthesis, and low toxicity, making them attractive for many applications in biology, medicine, and environmental areas. The synthesis of CDs is achievable by a variety of methods, including bottom-up and top-down approaches, involving the use of different carbon sources and surface functionalization strategies. However, understanding the fluorescence mechanism of CDs remains a challenge. Various mechanistic models have been proposed to explain their origin of luminescence. This review summarizes the recent developments in the synthesis and functionalization of CDs and provides an overview of the current understanding of the fluorescence mechanism.

Favorable control of hepatocellular carcinoma with peritoneal dissemination by surgical resection using indocyanine green fluorescence imaging: a case report and review of the literature

BACKGROUND

The optimal management for peritoneal dissemination in patients with hepatocellular carcinoma remains unclear. Although several reports have described the usefulness of surgical resection, the indications should be carefully considered. Herein, we report the case of a patient with hepatocellular carcinoma with peritoneal recurrence who underwent surgical resection using an indocyanine green fluorescence navigation system and achieved favorable disease control.

CASE PRESENTATION

A 45-year-old Asian woman underwent left hemihepatectomy for a ruptured hepatocellular carcinoma. Seventeen months after the initial surgery, a single nodule near the cut surface of the liver was detected on computed tomography, along with elevation of tumor markers. The patient was diagnosed with peritoneal metastasis and underwent a surgical resection. Twelve months later, a single nodule on the dorsal side of the right hepatic lobe was detected on computed tomography, and we performed surgical resection. Indocyanine green (0.5 mg/kg) was intravenously administered 3 days before surgery, and the indocyanine green fluorescence imaging system revealed clear green fluorescence in the tumor, which helped us perform complete resection. Indocyanine green fluorescence enabled the detection of additional lesions that could not be identified by preoperative imaging, especially in the second metastasectomy. There was no further recurrence at 3 months postoperatively.

CONCLUSION

When considering surgical intervention for peritoneal recurrence in patients with hepatocellular carcinoma, complete resection is mandatory. Given that disseminated nodules are sometimes too small to be detected by preoperative imaging studies, intraoperative indocyanine green fluorescence may be an essential tool for determining the indications for surgical resection.

Essential updates 2020/2021: Current topics of simulation and navigation in hepatectomy

With the development of three‐dimensional (3D) simulation software, preoperative simulation technology is almost completely established. The remaining issue is how to recognize anatomy three‐dimensionally. Extended reality is a newly developed technology with several merits for surgical application: no requirement for a sterilized display monitor, better spatial awareness, and the ability to share 3D images among all surgeons. Various technology or devices for intraoperative navigation have also been developed to support the safety and certainty of liver surgery. Consensus recommendations regarding indocyanine green fluorescence were determined in 2021. Extended reality has also been applied to intraoperative navigation, and artificial intelligence (AI) is one of the topics of real‐time navigation. AI might overcome the problem of liver deformity with automatic registration. Including the issues described above, this article focuses on recent advances in simulation and navigation in liver surgery from 2020 to 2021.

Successful application of ICG fluorescence imaging technology in rectal neuroendocrine tumor liver metastasis

We report the use of indocyanine green fluorescence imaging technology to assist the resection of rectal neuroendocrine tumors with liver metastases. The liver metastases of rectal neuroendocrine tumors show strong fluorescent signals, the tumor borders are clear, and there is no fluorescence at the resection margin, indicating that the tumor has been completely removed. Postoperative pathology also confirmed that the tumor margin was negative. ICG fluorescence imaging has great potential in assisting the resection of liver metastases of neuroendocrine tumors, and at the same time is able to assist in judging the removal of the tumor.