Present and futur of Fluorescent Guided Liver Surgery in resection and transplantation. I have made this conference at IFSBM meeting

1. Fluorescence in Liver surgery
Pr Eric Vibert, MD, PhD
Centre Hépato-Biliaire,
Hop. Paul Brousse, Villejuif

2. Disclosures
• Fees from Bayer, BMS, Johnson&Johnson
• Consultant for Nanobiotix and MID
• Academic collaboration with EchoSens,
Fluoptics and IntraSense

3. Liver Surgery
Must be feasible Must be useful

4. Liver Surgery & Transplantation are
the only curatives treatments of
liver cancer
If the patient stays alive after surgery….

5. Surgical Margins are Crucial

7. Feasibility of Liver Surgery ?
MELD < 10
MELD < 12
Independant predictive
factor of mortality
Cuccheti et al. Liver Transpl 2006Farges et al. Ann Surg 2012 Bruix et al. Gastroenterology 1996

8. When I plan a treatment to Mister
Durand, I think to Mister Dupond…
Who will be more beneficiated of
liver transplantation relatively to
resection ?
Risk and Interest of oncologic hepatectomy ?
VS

9. The location of HCC is determinant…
LiverSP by SIGHT

10. Liver Surgery
Must continue to improve

11. Impact of laparoscopic liver resection in patients with cirrhosis
on 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 2016
6 French HPB Centers
343 Hepatectomies in F3/F4 89 pts by Lap (26%)

12. 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

13. Fluorescent Guided Liver Surgery
Ishizawa. Cancer 2009 Ishizawa. Surg Endos 2016Ishizawa. Ann Surg Onc 2010

14. FluoBeam ® FluoSoft™
Collaboration with Centre Hepato-Biliaire and Fluoptic Company
Provision of Open Device (Fluobeam™) - No financial interest

15. • Indocyanine Green Dye (ICG) – Intravenous injection
• Passive hepatocytes captation and active biliary secretion
• Decrease of the ICG secretion  Decrease of liver function

16. 100%
40%
30%

17. 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

18. Indocyanine green processing by the liver

19. Time in s
Indocyanine green pharmaco-kinetic model
Predict intra-operatively the risk of post-operative liver failure
aims 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

21. 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

22. 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

25. With the courtesy of T. Ishizawa and M. Terasawa

26. Intraoperative Pathological Data
Macroscopic Scale and,
in a very next future, at
Microscopic scale…

27. 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…eric.vibert.pbr@gmail.fr

28. Golse, Cottin, Vibert et al.
Pessaux et al.
From virtual to real…
Open or Lap