Fluorescence Guided Surgery using Indocyanine Green for Pulmonary Osteosarcoma Metastasectomy in Pediatric Patients A feasibility study

BackgroundIn osteosarcoma patients, resection of pulmonary metastases is considered necessary for long term survival. Radiologically detected lesions are sometimes difficult to identify intraoperatively, especially when no palpation possible during thoracoscopy. In adults, fluorescence guided surgery (FGS) using indocyanine green (ICG) has been shown be a safe method intra-operative identification different primary tumors. Our aim determine the feasibility ICG in pediatric patients.MethodsNine consecutive patients with received an intravenous dose 24 hours preoperatively. We started adult dosage 0.5 mg/kg and also used 1.0 confirm that maximum fluorescent signal was achieved. Intra-operatively post-operatively, were visualized near-infrared camera system. Fluorescence quantified by calculating tumor-to-background ratio (TBR).ResultsTwo (22%) underwent thoracoscopy seven (78%) thoracotomy. Five (56%) had metastasis surgery. four (44%) there metastases. two necrotic. other two, intraoperative most likely hampered depth Ex vivo, all vital necrotic specimens not. There difference between concerning TBR. No adverse events occurred.ConclusionsICG metastasectomy feasible procedure population. However, its additional value guidance still investigated.