Can intra-operative fluorescence play a significant role in hepatobiliary surgery?

Liver resection remains the cornerstone of curative treatment for hepatocellular carcinoma and colorectal cancer liver metastases. Its success is dependent upon the extent of resection achieved. To this end, intra-operative imaging techniques have been experimented with to aid the surgeon. Fluorescence guided surgery (FGS) utilises the properties of near infrared light emitting molecules to identify malignant tissue, enabling the surgeon to maximise resection of diseased tissue and minimise collateral damage. Data from early trials showed increased superficial lesion detection when using fluorescence to guide liver resection. However, with far greater tissue penetration, intra-operative ultrasound (IOUS) remains the gold-standard intra-operative imaging modality. Subsequent trials have shown that the concomitant use of both FGS and IOUS may increase tumour detection rates intra-operatively. This review provides a comprehensive analysis of the most compelling evidence regarding fluorescence in hepatobiliary surgery and addresses the challenges faced introducing it into common practice.