Introduction : unfortunately colorectal cancer is still diagnosed in advanced stages of the disease in our country, a significant number of cases presenting liver metastases at the time of initial diagnostic. However, in certain cases although the preoperative imagistic studies raise the suspicion of metastatic liver disease, this fact is not demonstrated by the histopathological studies.

Methods : we present a case series of five patients in which suspected hepatic lesions were observed in the context of colorectal malignancies. In all cases indocyanine green was injected intravenously 48-72 hours preoperatively, the aspect of the lesions being evaluated in a laparoscopic manner. In all cases colorectal lesions were resected by using the minimally invasive approach.

Results : in three cases indocyanine green concentration at the level of the hepatic lesions was encountered, so conversion to open surgery and resection was performed. In the other two cases only peripheral captation was seen, so the lesions were considered to be benign; however laparoscopic biopsy was taken. The histopathological studies confirmed the presence of metastatic lesions in all three cases which had been submitted to resection as well as the presence of benign conditions in the other two cases. Therefore, unnecessary resection was avoided in these two cases.

Conclusions : preoperative injection of indocyanine green might be a valuable tool in order to differentiate benign and malignant lesions in patients with colorectal cancer and to avoid performing unnecessary liver surgery for cases in which malignancy is excluded.