Effectiveness and safety of indocyanine green fluorescence imaging-guided hepatectomy for liver tumors: A systematic review and first meta-analysis

Qi, Chi; Zhang, Hao; Chen, Yue; Su, Song; Huang, Xinqiao; Fang, Cheng; Li, Bo; Xia, XianMing; He, Pan

doi:10.1016/j.pdpdt.2019.10.007

Cited by 17 publications

(14 citation statements)

References 38 publications

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“…With further respect to safety using ICG with NIR light, several meta-analyses and larger clinical trials have assessed this issue. This includes a recent meta-analysis evaluating its use in the detection of hepatic tumors, 46 in which 6 studies incorporating 587 patients were analyzed; in this study, complication rates were lower in the fluorescence-guided versus standard white light hepatectomy group, and no serious reactions to ICG were reported. In another large nonrandomized study involving 847 women with clinically node-negative breast cancer undergoing sentinel lymph node assessments, again no allergic or any other serious adverse reactions to ICG were reported 47 .…”

Section: Discussionmentioning

confidence: 97%

Consensus Conference Statement on the General Use of Near-infrared Fluorescence Imaging and Indocyanine Green Guided Surgery

et al. 2020

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Background:In recent decades, the use of near-infrared light and fluorescence-guidance during open and laparoscopic surgery has exponentially expanded across various clinical settings. However, tremendous variability exists in how it is performed.Objective:In this first published survey of international experts on fluorescence-guided surgery, we sought to identify areas of consensus and nonconsensus across 4 areas of practice: fundamentals; patient selection/preparation; technical aspects; and effectiveness and safety.Methods:A Delphi survey was conducted among 19 international experts in fluorescence-guided surgery attending a 1-day consensus meeting in Frankfurt, Germany on September 8th, 2019. Using mobile phones, experts were asked to anonymously vote over 2 rounds of voting, with 70% and 80% set as a priori thresholds for consensus and vote robustness, respectively.Results:Experts from 5 continents reached consensus on 41 of 44 statements, including strong consensus that near-infrared fluorescence-guided surgery is both effective and safe across a broad variety of clinical settings, including the localization of critical anatomical structures like vessels, detection of tumors and sentinel nodes, assessment of tissue perfusion and anastomotic leaks, delineation of segmented organs, and localization of parathyroid glands. Although the minimum and maximum safe effective dose of ICG were felt to be 1 to 2 mg and >10 mg, respectively, there was strong consensus that determining the optimum dose, concentration, route and timing of ICG administration should be an ongoing research focus.Conclusions:Although fluorescence imaging was almost unanimously perceived to be both effective and safe across a broad range of clinical settings, considerable further research remains necessary to optimize its use.

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Section: Discussionmentioning

confidence: 97%

Consensus Conference Statement on the General Use of Near-infrared Fluorescence Imaging and Indocyanine Green Guided Surgery

et al. 2020

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“…The ICG plasma disappearance rate could be used to help decision making prior to major liver resections in order to minimize the risk of postoperative liver failure. More specific to surgical oncology hepatobiliary context, a recent meta-analysis showed that additional ICG fluorescence does decrease operative time, blood loss, hospital stay, and postoperative complications (26) . Also, some oncological cases may have benefits from ICG properties since its discovery of accumulation in the cancerous tissues of neoplastic lesions, such as hepatocellular carcinoma and in the noncancerous hepatic parenchyma around adenocarcinoma foci by Ishizawa et al (27) .…”

Section: Discussionmentioning

confidence: 99%

Indocyanine Green Fluorescence Imaging in Robotic Surgery: State of Art, Tips and Tricks in Current Applications

Morrell

Morrell-Junior

et al. 2021

Arq. Gastroenterol.

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BACKGROUND: Fluorescent imaging with indocyanine green is an emerging technology whose benefits are put in perspective. OBJECTIVE: This article reports essential principles and approaches of intraoperative fluorescence in general surgery bringing familiarity to its practical usage. Our group describes possible pitfalls and provides tips and tricks for training surgeons making their attempts easier and reproducible during practice. METHODS: This study overviews the most structured concepts, practical applications and its tricks in robotic fluorescence guided imaging surgery with indocyanine green. Possible pitfalls are emphasized and emerging fields of application are put in a perspective. RESULTS: Guided information and practical applications in several surgical fields are described for a safe and reproducible indocyanine green fluorescence imaging use. CONCLUSION: Robotic assisted surgery combined to fluorescence imaging technology represents a logical evolution in image guided surgery and technology familiarity with guided information may represent a wider and safer spectrum of use in surgeons’ hands.

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“…Because it can be absorbed exclusively by hepatocytes and excreted through bile without enterohepatic recirculation, ICG has gain the attention of hepatobiliary surgeons over the last two decades [ 7 ]. Intraoperative ICG fluorescence navigation might be a complementary solution to overcome the limitation of laparoscopic hepatectomy [ 4 , 8 ]. Its application can also improve the detection rate of liver tumor focus, especially small lesions in an early stage [ 9 – 11 ].…”

Section: Introductionmentioning

confidence: 99%

Indocyanine green fluorescence navigation in laparoscopic hepatectomy: a retrospective single-center study of 120 cases

Liang

Qian

et al. 2020

Surg Today

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Purpose To explore the role of indocyanine green (ICG) fluorescence navigation in laparoscopic hepatectomy and investigate if the timing of its administration influences the intraoperative observation. Methods The subjects of this retrospective study were 120 patients who underwent laparoscopic hepatectomy; divided into an ICG-FN group (n = 57) and a non-ICG-FN group (n = 63). We analyzed the baseline data and operative data. Results There were no remarkable differences in baseline data such as demographic characteristics, lesion-related characteristics, and liver function parameters between the groups. Operative time and intraoperative blood loss were significantly lower in the ICG-FN group. The rate of R0 resection of malignant tumors was comparable in the ICG-FN and non-ICG-FN groups, but the wide surgical margin rate was significantly higher in the ICG-FN group. The administration of ICG 0–3 or 4–7 days preoperatively did not affect the intraoperative fluorescence imaging. Operative time, intraoperative blood loss, and a wide surgical margin correlated with ICG fluorescence navigation. ICG fluorescence navigation helped to minimize intraoperative blood loss and achieve a wide surgical margin. Conclusion ICG fluorescence navigation is safe and efficient in laparoscopic hepatectomy. It helps to achieve a wide surgical margin, which could result in a better prognosis. The administration of ICG 0–3 days preoperatively is acceptable.

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Effectiveness and safety of indocyanine green fluorescence imaging-guided hepatectomy for liver tumors: A systematic review and first meta-analysis

Cited by 17 publications

References 38 publications

Consensus Conference Statement on the General Use of Near-infrared Fluorescence Imaging and Indocyanine Green Guided Surgery

Consensus Conference Statement on the General Use of Near-infrared Fluorescence Imaging and Indocyanine Green Guided Surgery

Indocyanine Green Fluorescence Imaging in Robotic Surgery: State of Art, Tips and Tricks in Current Applications

Indocyanine green fluorescence navigation in laparoscopic hepatectomy: a retrospective single-center study of 120 cases

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