innovation in liver surgery
TRANSCRIPT
Fluorescence in Liver surgery
Pr Eric Vibert, MD, PhD
Centre Hépato-Biliaire,
Hop. Paul Brousse, Villejuif
Disclosures
• Fees from Bayer, BMS, Johnson&Johnson
• Consultant for Nanobiotix and MID
• Academic collaboration with EchoSens, Fluoptics and IntraSense
Liver Surgery & Transplantation are the only curatives treatments of
liver cancer
If the patient stays alive after surgery….
Feasibility of Liver Surgery ?
MELD < 10
MELD < 12
Independant predictivefactor of mortality
Cuccheti et al. Liver Transpl 2006Farges et al. Ann Surg 2012 Bruix et al. Gastroenterology 1996
When I plan a treatment to MisterDurand, I think to Mister Dupond…Who will be more beneficiated ofliver transplantation relatively toresection ?
Risk and Interest of oncologic hepatectomy ?
VS
Impact of laparoscopic liver resection in patients with cirrhosison post-operative liver failure : A Propensity Score Analysis
M. Prodeau, S. Truant, E. Vibert, O. Farges, J.Y. Mabrut,
J. Hardwigsen, J.M. Régimbeau, G. Millet, O. Soubrane,
R. Adam, D. Cherqui, F.R. Pruvot, E. Boleslawski
The ACHBT French Hepatectomy Study Group
Oct 2012 – June 20166 French HPB Centers
343 Hepatectomies in F3/F4 89 pts by Lap (26%)
Incidence of Post-Operative Liver Failure
Matched-LAP Matched-OPEN
Age (years) 65.3 65.3
BMI (kg/m²) 26.9 26.9
MELD 8.6 8.5
Platelets (x 1000/mm3) 167 167
ICG (15 min) 15.2 % 15.0 %
HVPG (mmHg) 7.9 8.1
LS (kPa) 21.8 21.9
RLV (%) 88.6 87.6
16% in LAP and 32% in OPEN
OR 0.31 [0.12-0.78]; p<0.001
Fluorescent Guided Liver Surgery
Ishizawa. Cancer 2009 Ishizawa. Surg Endos 2016Ishizawa. Ann Surg Onc 2010
FluoBeam ® FluoSoft™
Collaboration with Centre Hepato-Biliaire and Fluoptic CompanyProvision of Open Device (Fluobeam™) - No financial interest
• Indocyanine Green Dye (ICG) – Intravenous injection
• Passive hepatocytes captation and active biliary secretion
• Decrease of the ICG secretion Decrease of liver function
iFLOW (ANR Tecsan) (2014-2017)
Coordination : Eric Vibert, Hop. Paul Brousse
Computer modelisation of hemodynamic, histological and fonctional events after major hepatectomy in pig to optimize of mecanical portal flow modulation
Time in s
Indocyanine green pharmaco-kinetic model
Predict intra-operatively the risk of post-operative liver failureaims to modified liver hemodynamics using mechanical portal flow modulation (Bucur et al… Vibert, Ann Surg 2017)
Audebert et al… Vignon-Clementel, J Biomech 2017 Bucur et al… Vibert, Ann Surg 2017
26 patients (20 HCC – 6 Colorectal LM) : intraoperative exploration with ICG cam
Only to detect subcapsular lesion / No clear data on clinical rentability
Cancer 2009
HCC : Fluorescent spot CRLM : Fluorescent ring
HCC : No functional
hepatocytes
170 patients operated by laparotomy for HCC who had received ICG (0.5 mg/kg) at least 48 hours before liver surgery
Intraop. detection of 21 new spots in 19 patients 14 HCC (8.2%) and 7 False-Positive
Low specificity in severe cirrhosis
Conclusions
• Fluorescent guided liver surgery could improved
Certainly, the diagnosis of superficial liver cancer
Probably, the liver graft evaluation at the end of LT
Perhaps, post-operative courses by decreasing the risk of post-operative liver failure
For more questions…[email protected]