Indocyanine green fluorescence-guided laparoscopic hepatectomy versus conventional laparoscopic hepatectomy for hepatocellular carcinoma: A single-center propensity score matching study

Jianxi, Wang; Xiongfeng, Zou; Zheng, Zehao; Zhang, Zhao; Peng, Tianyi; Lin, Ye; Jin, Haosheng; Jian, Zhixiang; Wang, Huiling

doi:10.3389/fonc.2022.930065

Cited by 14 publications

(17 citation statements)

References 42 publications

(52 reference statements)

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“…A total of six studies [ 25 – 27 , 29 – 31 ] provided data on the postoperative overall complications rate, revealing a rate of 27.6% (66/239) in the ICG group and 25.4% (75/295) in the non-ICG group. Although there was moderate heterogeneity ( I 2 = 22%, P = 0.27), the analysis indicated no significant disparities between the two groups (OR = 0.96, 95% CI 0.53–1.76, P = 0.9) (Fig.…”

Section: Resultsmentioning

confidence: 99%

“…Regarding postoperative bleeding, data from five studies [ 25 – 27 , 29 , 30 ] showed a rate of 3.1% (6/191) in the ICG group and 2.1% (5/235) in the non-ICG group. In terms of postoperative liver failure, four studies [ 25 – 27 , 29 ] reported an incidence of 4.3% (6/141) in the ICG group and 2.7% (5/185) in the non-ICG group.…”

Section: Resultsmentioning

confidence: 99%

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Surgical margin status outcome of intraoperative indocyanine green fluorescence-guided laparoscopic hepatectomy in liver malignancy: a systematic review and meta-analysis

Tangsirapat,

Kengsakul,

Udomkarnjananun

et al. 2024

BMC Surg

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Background Hepatectomy stands as a curative management for liver cancer. The critical factor for minimizing recurrence rate and enhancing overall survival of liver malignancy is to attain a negative margin hepatic resection. Recently, Indocyanine green (ICG) fluorescence imaging has been proven implemental in aiding laparoscopic liver resection, enabling real-time tumor identification and precise liver segmentation. The purpose of this study is to conduct a systematic review and meta-analysis to ascertain whether ICG-guided laparoscopic hepatectomy yields a higher incidence of complete tumor eradication (R0) resections. Methods The search encompassed databases such as PubMed, Cochrane Library database, Scopus, ScienceDirect, and Ovid in April 2024, in strict adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies involving patients with malignant liver lesions who underwent ICG-guided laparoscopic hepatectomy and reported R0 resection outcomes were eligible for inclusion in this review. Results In a total of seven studies, involving 598 patients, were included in the meta-analysis. The ICG demonstrated a significantly elevated R0 resection rate compared to the non-ICG group [98.6% (359/364) vs. 93.1% (339/364), odds ratio (OR) = 3.76, 95% confidence intervals (CI) 1.45–9.51, P = 0.005]. Notably, no heterogeneity was observed (I2 = 0%, P = 0.5). However, the subtype analysis focusing on hepatocellular carcinoma [98.2% (165/168) vs. 93.6% (161/172), OR = 3.34, 95% CI 0.94–11.91, P = 0.06) and the evaluation of margin distance (4.96 ± 2.41 vs. 2.79 ± 1.92 millimeters, weighted mean difference = 1.26, 95% CI -1.8-4.32, P = 0.42) revealed no apparent differences. Additionally, the incidence of overall postoperative complications was comparable between both groups, 27.6% (66/239) in the ICG group and 25.4% (75/295) in the non-ICG group (OR = 0.96, 95% CI 0.53–1.76, P = 0.9). No disparities were identified in operative time, intraoperative blood loss, postoperative blood transfusion, and length of hospital stay after the surgery. Conclusions The implementation of ICG-guided laparoscopic hepatectomy can be undertaken with confidence, as it does not compromise either intraoperative or postoperative events. Furthermore, the ICG-guided approach is beneficial to achieving a complete eradication of the tumor during hepatic resection. Trial registration PROSPERO registration number CRD42023446440.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Surgical margin status outcome of intraoperative indocyanine green fluorescence-guided laparoscopic hepatectomy in liver malignancy: a systematic review and meta-analysis

Tangsirapat,

Kengsakul,

Udomkarnjananun

et al. 2024

BMC Surg

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“…Despite the challenges posed by disoriented vascular structures, our increased experience in hepatectomy enables us to rapidly adapt and comprehend these changes through a comprehensive preoperative review. Additionally, the use of repeat intraoperative ultrasound and ICG (indocyanine green) scope navigation assists in correlating preoperative imaging with intraoperative structural changes, ensuring greater surgical precision [22].…”

Section: Discussionmentioning

confidence: 99%

Revisiting the Surgical Approach for Recurrent Hepatocellular Carcinoma: Insights from a Single Institute's Experience in Overcoming Challenges

Chen,

Soong,

Chiang

et al. 2024

Preprint

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Introduction: Hepatocellular carcinoma (HCC) prevails in Taiwan, primarily attributed to the high incidence of hepatitis B and hepatitis C infections with high recurrent rates of 50-70% within five years after initial treatment. When confronted with recurrent HCC, treatment options include salvage liver transplantation, trans-arterial chemo-embolization (TACE), re-hepatectomy, and radio-frequency ablation (RFA). Notably, repeat hepatectomy exhibits superior oncological outcomes compared to alternative approaches. While laparoscopic liver resection (LLR) has demonstrated safety and feasibility in primary HCC resection, the persistence of intra-hepatic recurrence necessitates effective interventions. However, repeat liver resection posed challenges, including adhesions from previous surgeries, limited access to recurrent tumors, altered liver structure post-regeneration, difficulties in obtaining hilar control, and compromised liver reserve. Patients and methods: We retrospectively review our collective experience spanning January 2009 to December 2021, encompassing 57 patients with recurrent HCC. Among them, 37 patients underwent laparoscopic approaches, while 20 patients opted for traditional procedures. Results: Notably, both groups exhibited similar operative times and perioperative outcomes, with significantly reduced hospital stays observed in the laparoscopic cohort (median: 5 vs 7, p<0.001). The introduction of laparoscopic techniques also sparked a strategy shifting in our surgical approach to recurrent HCC. Conclusion: Our manuscript aims to delineate a stepwise approach for navigating the challenges inherent in repeat operations, elucidating techniques for peritoneal cavity entry, meticulous adhesiolysis, effective Pringle maneuver application, tumor identification, and pertinent insights into perioperative outcomes. Under the stepwise approach, laparoscopic repeat liver resection can be performed safely and effectively with low incidence of conversion. This treatment choice should be offered to the patient in a mature surgical team of minimal invasive liver resection.

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“…The advantage of ICG fluorescence laparoscopy over conventional laparoscopy is the ability to detect micrometastases and satellite lesions during surgery [ 23 , 24 ]. Intraoperative detection and management of micrometastases other than primary lesions are very important for patient prognosis.…”

Section: Discussionmentioning

confidence: 99%

Application of Indocyanine Green Fluorescence Imaging Combined with Laparoscopic Ultrasound in Laparoscopic Microwave Ablation of Liver Cancer

Guo

et al. 2022

Med Sci Monit

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Background The aim of this study was to assess the effect of indocyanine green (ICG) fluorescence imaging combined with laparoscopic ultrasound in laparoscopic microwave ablation of liver cancer. Material/Methods This study retrospectively analyzed 61 patients who underwent laparoscopic microwave ablation of liver cancer, including laparoscopic microwave ablation with and without ICG fluoroscopy. Results The operative times, ablation times, postoperative hospital stay, postoperative complication rate, hospitalization cost, postoperative liver function changes, and postoperative overall survival were similar between the 2 groups, but there was a statistically significant difference in recurrence-free survival ( P <0.05). A total of 5 lesions were found in the fluorescence laparoscopy group that were not found by preoperative imaging, while no new lesions were found in the ordinary laparoscopy group. Fluorescence laparoscopy has obvious advantages over ordinary laparoscopy in finding small lesions that were not found before surgery. In terms of complete ablation rate, 3 patients in the ordinary laparoscopy group and 1 patient in the fluorescence laparoscopy group were judged to be incompletely ablated and were ablated again at 1 month after the operation. Conclusions For small hepatocellular carcinoma with severe liver cirrhosis and located on the liver surface, fluorescence laparoscopy can better reveal the location and boundary of the tumor, and fluorescence laparoscopy can detect tiny lesions that cannot be detected by preoperative imaging. The combination of fluorescence laparoscopy and microwave ablation has a good effect on the treatment of small hepatocellular carcinoma located on the surface of the liver that is difficult to distinguish.

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Indocyanine green fluorescence-guided laparoscopic hepatectomy versus conventional laparoscopic hepatectomy for hepatocellular carcinoma: A single-center propensity score matching study

Cited by 14 publications

References 42 publications

Surgical margin status outcome of intraoperative indocyanine green fluorescence-guided laparoscopic hepatectomy in liver malignancy: a systematic review and meta-analysis

Surgical margin status outcome of intraoperative indocyanine green fluorescence-guided laparoscopic hepatectomy in liver malignancy: a systematic review and meta-analysis

Revisiting the Surgical Approach for Recurrent Hepatocellular Carcinoma: Insights from a Single Institute's Experience in Overcoming Challenges

Application of Indocyanine Green Fluorescence Imaging Combined with Laparoscopic Ultrasound in Laparoscopic Microwave Ablation of Liver Cancer

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