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Updated: Mar 14, 2026
Fluorescent Laparoscopic Central Hepatectomy for Liver Cancer Using Indocyanine Green Negative Staining
Published on: March 17, 2023
Effective fluorescence-guided surgery of liver metastasis using a fluorescent anti-CEA antibody
Yukihiko Hiroshima1,2,3, Thinzar M Lwin1,2, Takashi Murakami1,2,3
1Department of Surgery, University of California San Diego, San Diego, California.
Background And Objectives:
Delineation of adequate tumor margins is critical in oncologic surgery, particularly in resection of metastatic lesions. Surgeons are limited in visualization with bright-light surgery, but fluorescence-guided surgery (FGS) has been efficacious in helping the surgeon achieve negative margins.
Methods:
The present study uses FGS in a mouse model that has undergone surgical orthotopic implantation (SOI) of colorectal liver metastasis tagged with green fluorescent protein (GFP). An anti-CEA antibody conjugated to DyLight 650 was used to highlight the tumor.
Results:
The fluorescent antibody clearly demarcated the lesion at deeper tissue depth compared to GFP. Fluorescence of the anti-CEA-DyLight650 showed maximal tumor-to-liver contrast at 72 hr. Fifteen mice underwent bright-light surgery (BLS) versus FGS with GFP versus FGS with anti-CEA-DyLight650. Mice that underwent FGS had a significantly smaller area of residual tumor (P < 0.001) and significantly longer overall survival (P < 0.001) and disease-free survival (P < 0.001). Within the two FGS groups, mice undergoing surgery with anti-CEA-DyLight650 improved survival compared to only GFP labeling.
Conclusions:
In the present report, we demonstrate that an anti-CEA antibody conjugated to a DyLight 650 nm dye clearly labeled colon cancer liver metastases, thereby enabling successful FGS. J. Surg. Oncol. 2016;114:951-958. © 2016 Wiley Periodicals, Inc.
Insights
Fluorescence-guided surgery (FGS) using an anti-CEA antibody improved outcomes for colorectal liver metastases. This method enhanced tumor visualization, leading to better survival rates and reduced residual tumor compared to standard surgery.
Area of Science:
- Oncology
- Surgical Oncology
- Medical Imaging
Background:
- Achieving adequate tumor margins is crucial in oncologic surgery for metastatic lesions.
- Bright-light surgery (BLS) has limitations in visualizing tumors, potentially leading to incomplete resection.
- Fluorescence-guided surgery (FGS) offers enhanced visualization to improve surgical outcomes.
Purpose of the Study:
- To evaluate the efficacy of FGS using an anti-CEA antibody conjugated to DyLight 650 for colorectal liver metastases in a mouse model.
- To compare the effectiveness of FGS with different fluorescent tags against BLS.
Main Methods:
- A mouse model of surgical orthotopic implantation (SOI) of colorectal liver metastasis was utilized.
- Tumors were tagged with green fluorescent protein (GFP) and highlighted using an anti-CEA antibody conjugated to DyLight 650.
- Surgical procedures included BLS, FGS with GFP, and FGS with anti-CEA-DyLight 650.
Main Results:
- The anti-CEA-DyLight 650 conjugate provided clearer demarcation of liver metastases at deeper tissue depths compared to GFP alone.
- Maximal tumor-to-liver contrast was observed at 72 hours post-injection with anti-CEA-DyLight 650.
- Mice undergoing FGS demonstrated significantly reduced residual tumor area (P < 0.001) and improved overall and disease-free survival (P < 0.001) compared to BLS.
- FGS with anti-CEA-DyLight 650 resulted in superior survival outcomes compared to FGS with GFP alone.
Conclusions:
- An anti-CEA antibody conjugated to DyLight 650 effectively labels colon cancer liver metastases, enabling successful FGS.
- This approach enhances tumor visualization and improves surgical resection, leading to better patient survival.
- FGS with targeted antibodies represents a promising advancement in oncologic surgery for metastatic disease.
