Application of ICG fluorescence navigation during salvage surgery for advanced oral squamous cell carcinoma

doi:10.19438/j.cjoms.2023.03.007

Abstract

Abstract: PURPOSE: To investigate the efficacy of indocyanine green (ICG) fluorescence navigation technique in the detection of safe surgical margins of advanced oral squamous cell carcinoma (OSCC). METHODS: Forty-eight patients with advanced oral squamous cell carcinoma treated in the First Ward of Department of Oral and Maxillofacial Surgery, Nanjing Stomatological Hospital were divided into ICG group(n=25) and non-ICG group(n=23). The tumor was removed in ICG group with the assistance of ICG fluorescence navigation technology, and the tumor was removed in non-ICG group with conventional methods, and the cutting edge tissues of the two groups underwent frozen biopsy. The operative time, intraoperative blood loss, abnormal margin rate and prognosis of the two groups were observed and compared, and the data were statistically analyzed by SPSS 22.0 software package. RESULTS: The operation was successfully completed in all 48 patients, and the lesion resection was complete and an adequate surgical safety margin was guaranteed. In the ICG group, the tumor fluorescence was visualized in all lesions with clear tumor boundary under the excitation of near-infrared fluorescence molecular imaging. The mean operative time was 8.1 hours, the mean intraoperative blood loss was 856.4 mL, and the rate of abnormal margins was 1.8%. The mean operative time in the non-ICG group was 7.7 hours, the mean intraoperative blood loss was 796.1 mL, and the rate of abnormal margins was 6.9%. By December 2022, 3 patients in the ICG group had died due to recurrence and 1 patient had died due to distant metastasis after surgery. In the control group, 4 cases died due to recurrence and 1 case died due to postoperative pulmonary infection. CONCLUSIONS: ICG mediated near infrared fluorescence imaging technology provides a new method for observing and completely resecting the tumor under direct vision during operation, and finding the residual tumor at the cutting edge in time, which has a certain significance in the treatment of advanced oral squamous cell carcinoma.

Key words: Near infrared fluorescence molecular imaging technology, Advanced oral squamous cell carcinoma, Surgical safety margin, Indocyanine green

CLC Number:

R739.8

WU Zhu-hao, ZHANG Xing-wei, SUN Ya-wei, LI Zi-hui, CHEN Xin, PU Yu-mei, HU Qin-gang, DONG Ying-chun, SUN Guo-wen. Application of ICG fluorescence navigation during salvage surgery for advanced oral squamous cell carcinoma[J]. China Journal of Oral and Maxillofacial Surgery, 2023, 21(3): 248-252.

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