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Systematic review, meta-analysis and single-centre experience of the diagnostic accuracy of intraoperative near-infrared indocyanine green-fluorescence in detecting pancreatic tumours

  • Gianluca Rompianesi
    Correspondence
    Correspondence: Gianluca Rompianesi, Division of Hepato-Bilio-Pancreatic, Minimally Invasive and Robotic Surgery, Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy.
    Affiliations
    Division of Hepato-Bilio-Pancreatic, Minimally Invasive, Robotic and Transplant Surgery, Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy
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  • Roberto Montalti
    Affiliations
    Division of Hepato-Bilio-Pancreatic, Minimally Invasive, Robotic and Transplant Surgery, Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy
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  • Mariano C. Giglio
    Affiliations
    Division of Hepato-Bilio-Pancreatic, Minimally Invasive, Robotic and Transplant Surgery, Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy
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  • Carlo D.L. Ceresa
    Affiliations
    Nuffield Department of Surgical Sciences, University of Oxford, UK
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  • Riccardo A. Nasto
    Affiliations
    Division of Hepato-Bilio-Pancreatic, Minimally Invasive, Robotic and Transplant Surgery, Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy
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  • Giuseppe De Simone
    Affiliations
    Division of Anaesthesia of Hepato-Bilio-Pancreatic and Liver Transplant Surgery, Department of General Surgery and Surgical Specialties, Kidney Transplantation, Intensive Care and Nephrology, Federico II University Hospital, Naples, Italy
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  • Roberto I. Troisi
    Affiliations
    Division of Hepato-Bilio-Pancreatic, Minimally Invasive, Robotic and Transplant Surgery, Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy
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      Abstract

      Background

      During pancreatic resections assessing tumour boundaries and identifying the ideal resection margins can be challenging due to the associated pancreatic gland inflammation and texture. This is particularly true in the context of minimally invasive surgery, where there is a very limited or absent tactile feedback. Indocyanine green (ICG) fluorescence imaging can assist surgeons by simply providing valuable real-time intraoperative information at low cost with minimal side effects. This meta-analysis summarises the available evidence on the use of near-infrared fluorescence imaging with ICG for the intraoperative visualization of pancreatic tumours (PROSPERO ID: CRD42021247203).

      Methods

      MEDLINE, Embase, and Web Of Science electronic databases were searched to identify manuscripts where ICG was intravenously administered prior to or during pancreatic surgery and reporting the prevalence of pancreatic lesions visualised through fluorescence imaging.

      Results

      Six studies with 7 series’ reporting data on 64 pancreatic lesions were included in the analysis. MINOR scores ranged from 6 to 10, with a median of 8. The most frequent indications were pancreatic adenocarcinoma and neuroendocrine tumours. In most cases (67.2%) ICG was administered during surgery. ICG fluorescence identified 48/64 lesions (75%) with 81.3% accuracy, 0.788 (95%CI 0.361–0.961) sensitivity, 1 (95%CI 0.072–1) specificity and positive predictive value of 0.982 (95%CI 0.532–1). In line with the literature, ICG fluorescence identified 5/6 (83.3%) of pancreatic lesions during robotic pancreatic resections performed at our Institution.

      Conclusion

      This meta-analysis is the first summarising the results of ICG immunofluorescence in detecting pancreatic tumours during surgery, showing good accuracy. Additional research is needed to define optimal ICG administration strategies and fluorescence intensity cut-offs.
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