I-FIGS Feasibility Study

Hepatocellular Carcinoma Clinical Trial

— I-FIGS  

Official title:

A Feasibility Randomised Controlled Study to Test the Use of Indocyanine Green Fluorescence Image-Guidance in Liver Surgery Compared to Standard Liver Surgery Alone in Reducing Microscopic Positive Tumour Resection Rate

Clinical Trial Details — Status: Active, not recruiting

Administrative data

• NCT number: NCT05616039
• Other study ID #: 317378
• Status: Active, not recruiting
• Phase: N/A
• Start date: November 23, 2022
• Est. completion date: April 30, 2024

Study information

• Verified date: March 2024
• Source: University Hospital Plymouth NHS Trust
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

Background:

Removal of part of the liver (resection) is performed as a treatment for some cancers in the liver. To achieve the best possible outcomes, it is important that the cancer is removed completely (R0 resection) (1). Up to 30-50% patients develop recurrence within 2 years of surgery which could be due to incomplete removal of the cancer (2). Various techniques are used by the surgeons to identify the cancer tissue from the normal liver during the surgery so that it can be removed completely. These include examining with the naked eye, having a feel of the tumour, and performing an ultrasound scan. Even with these techniques it is difficult to identify the exact extent of the cancer. Also, the interpretation of the ultrasound scan can be subjective (3). A robust, objective, real-time navigation technique is required which can differentiate cancer from normal tissue.

Indocyanine green (ICG) is a dye which when given through the veins, is taken up and retained by cancer cells in the liver and they appear as fluorescent areas as compared to normal liver which appears dark. This principle can be used to identify the cancerous tissue accurately during the surgery and remove it completely (Indocyanine green Fluorescence Image-Guided Surgery: I-FIGS). It can also potentially detect additional tumours which were not identified before the surgery or during the surgery with standard techniques (4,5). However, there is a lack of good quality evidence on the usefulness of I-FIGS in liver surgery, so this needs to be tested in a large group of patients having liver surgery before any recommendations can be made.

Research Aim:

This initial study aims to assess whether a larger trial evaluating the role of I-FIGS in complete removal of the cancer tissue is feasible. Investigators will assess if patients are willing to take part in the study and whether they can gather relevant clinical outcome data from them all. Investigators will also gather patients' views about this novel technique and participating in the study.

Design and methods:

This study will involve 40 patients having planned liver surgery for liver tumour/s recruited from University Hospitals, Plymouth. Patients will be randomly allocated to have I-FIGS plus standard surgery or standard liver surgery alone. Patients in the I-FIGS group will have ICG injection 2-4 hrs prior to surgery (0.03-0.05mg/kg dose) on the day of surgery. The surgical planning will be carried out as per the standard approach using the naked eye and intra-operative ultrasound examination. Once this is all recorded, ICG cameras will be switched on, and the additional findings and change to surgical plan will be noted. Focus groups will explore participants experiences of being in the study. This will inform the design of the future larger trial.

Patient public involvement:

Investigators have involved patients who have had or are having liver surgery in the development of the study. Their views on the technique, trial procedures and outcome measures have been incorporated. They will continue to be involved and advise on the study.

Dissemination:

Results will be available via research journals and conferences.

Recruitment information / eligibility

• Status: Active, not recruiting
• Enrollment: 40
• Est. completion date: April 30, 2024
• Est. primary completion date: April 30, 2024
• Accepts healthy volunteers: No
• Gender: All
• Age group: 16 Years and older

Eligibility

Inclusion Criteria:

• All adult patients (>16 years) requiring elective open/laparoscopic liver resection/s for liver metastases, primary hepatocellular and peripheral cholangiocarcinoma will be included in the study.

Exclusion Criteria:

• Patients allergic to iodine/contrast or shellfish

• Patients unable to consent to the study

• Patients with suspected liver adenomas and biliary cystadenomas

• Patients with suspected hilar cholangiocarcinoma

• Patients requiring emergency liver surgery

• Pregnant patients

Related Conditions & MeSH terms

• Carcinoma, Hepatocellular
• Hepatocellular Carcinoma
• Liver Cancer
• Liver Metastasis Colon Cancer
• Liver Neoplasms

Intervention

Procedure:
• Standard Liver Surgery
Standard liver surgery using naked eye examination +/- palpation and intra-operative ultrasound scan (IOUS) examination to identify and remove liver tumours

Diagnostic Test:
• Indocyanine Fluorescent Image Guided Surgery (I-FIGS)
Use of I-FIGS in accurate identification of tumours and their margins

Locations

Country	Name	City	State
United Kingdom	University Hospitals Plymouth NHS Trust	Plymouth

Sponsors (1)

Lead Sponsor	Collaborator
University Hospital Plymouth NHS Trust

Country where clinical trial is conducted

United Kingdom, 

References & Publications (5)

Chan AWH, Zhong J, Berhane S, Toyoda H, Cucchetti A, Shi K, Tada T, Chong CCN, Xiang BD, Li LQ, Lai PBS, Mazzaferro V, Garcia-Finana M, Kudo M, Kumada T, Roayaie S, Johnson PJ. Development of pre and post-operative models to predict early recurrence of hepatocellular carcinoma after surgical resection. J Hepatol. 2018 Dec;69(6):1284-1293. doi: 10.1016/j.jhep.2018.08.027. Epub 2018 Sep 18. — View Citation

Faybik P, Hetz H. Plasma disappearance rate of indocyanine green in liver dysfunction. Transplant Proc. 2006 Apr;38(3):801-2. doi: 10.1016/j.transproceed.2006.01.049. — View Citation

Ishizawa T, Saiura A, Kokudo N. Clinical application of indocyanine green-fluorescence imaging during hepatectomy. Hepatobiliary Surg Nutr. 2016 Aug;5(4):322-8. doi: 10.21037/hbsn.2015.10.01. — View Citation

Joo I. The role of intraoperative ultrasonography in the diagnosis and management of focal hepatic lesions. Ultrasonography. 2015 Oct;34(4):246-57. doi: 10.14366/usg.15014. Epub 2015 Apr 6. — View Citation

Mise Y, Sakamoto Y, Ishizawa T, Kaneko J, Aoki T, Hasegawa K, Sugawara Y, Kokudo N. A worldwide survey of the current daily practice in liver surgery. Liver Cancer. 2013 Jan;2(1):55-66. doi: 10.1159/000346225. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Feasibility outcomes	screening and recruitment rate; retention rate; adherence rates to study methods and procedures (consent, randomisation, intervention, data collection)	10 weeks (from the day of recruitment till the histopathology report is available)
Primary	Clinical outcomes- Microscopic positive resection margin rate	Number of patients with microscopic positive resection margins as compared to total number of patients, measured as percentage.; Microscopic positive resection margin is defined as presence of tumour cells < 1 mm from the resection margin.	From the day of surgery till the histopathology report is available (approximately 6 weeks)
Secondary	Number of additional tumours detected	Number of additional tumours detected by I-FIGS compared to Intra-operative ultrasound scan (IOUS) will be noted for each patient. A median value and range will be calculated for both the groups.	On the day of surgery
Secondary	Duration of surgery	This will be measured in minutes on the day of surgery. This will include the time from the time incision is taken (knife to skin) till the patient is extubated. A median value and range will be calculated for both the groups.	On the day of surgery
Secondary	Post-operative length of stay	This will be measured in number of days for each patient. A median value and range will be calculated for both the groups.	From the day of surgery till the day of discharge (approximately 10 days)
Secondary	Complications	If case of any complications, these will be graded as per the Clavien-Dindo grading system.; The unit of measure will be the Clavien-Dindo grade.	From the day of recruitment till the day of discharge (approximately 4 weeks)