Application of fusion ICG-fluorescence imaging in laparoscopic anatomical hepatectomy for primary liver cancer

doi:10.3877/cma.j.issn.2095-3232.2023.01.008

Abstract

Abstract:

Objective

To evaluate the application value of fusion ICG-fluorescence imaging (FIGFI) in laparoscopic anatomical hepatectomy (LAH) for primary liver cancer (PLC).

Methods

Clinical data of 70 PLC patients who underwent LAH in the Third People's Hospital Affiliated to Nantong University from March 2018 to December 2021 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 47 patients were male and 23 female, aged from 35 to 76 years, with a median age of 58 years. According to different surgical methods, all patients were divided into the FIGFI-LAH (n=31) and LAH groups (n=39). Preoperative conditions, conversion rate to open surgery, hepatic portal occlusion time, operation time, intraoperative blood loss, postoperative complications, postoperative recurrence and survival were compared between two groups. The positive margin rate was compared by Chi-square test. The survival curve was delineated by Kaplan-Meier method. The 1-, 2- and 3-year recurrence and survival rates were compared by Z test.

Results

In the FIGFI-LAH group, 1 case was converted to open surgery, 2 cases in the LAH group. The remaining patients successfully completed the surgery. The positive margin rate in the FIGFI-LAH group was 3%(1/31), significantly lower than 21%(8/39) in the LAH group (χ²=4.607, P<0.05). In the FIGFI-LAH group, the 1-, 2-, 3-year cumulative recurrence rates were 3%, 14%, 22%, and 5%, 17%, 72% in the LAH group, respectively. The 3-year cumulative recurrence rate in the FIGFI-LAH group was significantly lower than that in the LAH group(Z=-5.705, P<0.05). The 1-, 2-, 3-year cumulative survival rates in the FIGFI-LAH group were 100%, 100%, 84%, and 97%, 91% and 53% in the LAH group, respectively. The 3-year cumulative survival rate in the FIGFI-LAH group was significantly higher than that in the LAH group (Z=4.478, P<0.05).

Conclusions

It is safe and feasible to apply FIGFI in LAH, which can realize visual display of tumor margin and precise hepatectomy, effectively reduce the positive margin rate and contribute to enhancing the long-term survival rate of PLC patients.

Key words: Liver neoplasms, Laparoscopes, Hepatectomy, Indocyanine green, Fluorescence imaging

Xiao Tang, Zhiqiang Yue, Weihua Cai, Lin Chen, Linling Ju, Jixiang Yuan, Jianghua Zhao, Jinzhu Wu. Application of fusion ICG-fluorescence imaging in laparoscopic anatomical hepatectomy for primary liver cancer[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2023, 12(01): 39-43.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhgzwkssxdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-3232.2023.01.008

https://zhgzwkssxdzzz.cma-cmc.com.cn/EN/Y2023/V12/I01/39

Figures/Tables 4

References 21

[1]	马家豪, 王连才, 王亚峰, 等. 吲哚菁绿荧光融合影像技术在腹腔镜肝癌解剖性肝切除术中的应用[J]. 中华普通外科杂志, 2019, 34(7):586-589.
[2]	王晓颖, 高强, 朱晓东, 等. 腹腔镜超声联合三维可视化技术引导门静脉穿刺吲哚菁绿荧光染色在精准解剖性肝段切除术中的应用[J]. 中华消化外科杂志, 2018, 17(5):979-986.
[3]	Yang J, Tao HS, Cai W, et al. Accuracy of actual resected liver volume in anatomical liver resections guided by 3-dimensional parenchymal staining using fusion indocyanine green fluorescence imaging[J]. J Surg Oncol, 2018, 118(7):1081-1087.
[4]	Bonadio L, Iacuzzo C, Cosola D, et al. Indocyanine green-enhanced fluorangiography (ICGf) in laparoscopic extraperitoneal rectal cancer resection[J]. Updates Surg, 2020, 72(2):477-482.
[5]	刘茂兴, 邢加迪, 苏向前. 吲哚菁绿标记的近红外荧光腹腔镜技术在胃癌手术中的应用[J]. 中华肿瘤杂志, 2019, 41(12):891-895.
[6]	Kim YS, Choi SH. Pure laparoscopic living donor right hepatectomy using real-time indocyanine green fluorescence imaging[J].J Gastrointest Surg, 2019, 23(8):1711-1712.
[7]	Kaplan-Marans E, Fulla J, Tomer N, et al. Indocyanine green (ICG) in urologic surgery[J]. Urology, 2019(132):10-17.
[8]	姚舜禹, 荚卫东, 葛勇胜，等. 吲哚氰绿荧光示踪技术在肝癌解剖性肝切除中的应用[J/CD]. 中华肝脏外科手术学电子杂志, 2019, 8(3):221-225.
[9]	Felli E, Ishizawa T, Cherkaoui Z, et al. Laparoscopic anatomical liver resection for malignancies using positive or negative staining technique with intraoperative indocyanine green-fluorescence imaging[J]. HPB, 2021, 23(11):1647-1655.
[10]	Bakheet AMH, Zhao C, Chen JN, et al. Improving pathological early diagnosis and differential biomarker value for hepatocellular carcinoma via RNAscope technology[J]. Hepatol Int, 2020, 14(1): 96-104.
[11]	皮志恢, 刘辉, 龚帅昌, 等. 吲哚氰绿荧光成像技术在肝胆外科中的应用[J/OL]. 中华肝脏外科手术学电子杂志, 2021, 10(6): 555-559.
[12]	蓝伟锋, 陈志坚, 洪汉崟, 等. 吲哚菁绿在腹腔镜肝切除中的应用[J/CD]. 中华普通外科学文献(电子版), 2021, 15(4):309-312.
[13]	Nishino H, Hatano E, Seo S, et al. Real-time navigation for liver surgery using projection mapping with indocyanine green fluorescence: development of the novel medical imaging projection system[J]. Ann Surg, 2018, 267(6):1134-1140.
[14]	中国研究型医院学会微创外科学专业委员会, 《腹腔镜外科杂志》编辑部. 吲哚菁绿荧光染色在腹腔镜肝切除术中应用的专家共识[J]. 腹腔镜外科杂志, 2019, 24(5):388-394.
[15]	Inoue Y, Arita J, Sakamoto T, et al. Anatomical liver resections guided by 3-dimensional parenchymal staining using fusion indocyanine green fluorescence imaging[J]. Ann Surg, 2015, 262(1): 105-111.
[16]	Kobayashi Y, Kawaguchi Y, Kobayashi K, et al. Portal vein territory identification using indocyanine green fluorescence imaging: technical details and short-term outcomes[J]. J Surg Oncol, 2017, 116(7):921-931.
[17]	Kudo H, Ishizawa T, Tani K, et al. Visualization of subcapsular hepatic malignancy by indocyanine-green fluorescence imaging during laparoscopic hepatectomy[J]. Surg Endosc, 2014, 28(8):2504-2508.
[18]	Tanaka T, Takatsuki M, Hidaka M, et al. Is a fluorescence navigation system with indocyanine green effective enough to detect liver malignancies?[J]. J Hepatobiliary Pancreat Sci, 2014, 21(3):199-204.
[19]	Terasawa M, Ishizawa T, Mise Y, et al. Applications of fusion-fluorescence imaging using indocyanine green in laparoscopic hepatectomy[J]. Surg Endosc, 2017, 31(12):5111-5118.
[20]	Masuda K, Kaneko J, Kawaguchi Y, et al. Diagnostic accuracy of indocyanine green fluorescence imaging and multidetector row computed tomography for identifying hepatocellular carcinoma with liver explant correlation[J]. Hepatol Res, 2017, 47(12):1299-1307.
[21]	Otsuka Y, Matsumoto Y, Ito Y, et al. Intraoperative guidance using ICG fluorescence imaging system for safe and precise laparoscopic liver resection[J]. Minerva Surg, 2021, 76(3):211-219.

组别	例数	性别（例）		年龄（岁，±s）	肿瘤直径[M（Q_R）]	BMI（kg/m²，±s）	ICGR15[M（Q_R）]	Child-Pugh分级（例）
组别	例数	男	女	年龄（岁，±s）	肿瘤直径[M（Q_R）]	BMI（kg/m²，±s）	ICGR15[M（Q_R）]	A	B
FIGFI-LAH组	31	20	11	61±10	2.3（1.3）	23.6±2.8	0.062（0.052）	29	2
LAH组	39	27	12	59±9	2.3（1.5）	23.8±3.0	0.059（0.069）	34	5
统计值		χ²=0.174		t=1.072	Z=-0.373	t=-0.221	Z=0.112	χ²=0.778
P值		0.677		0.287	0.709	0.826	0.911	0.378

组别	例数	性别（例）		年龄（岁，±s）	肿瘤直径[M（Q_R）]	BMI（kg/m²，±s）	ICGR15[M（Q_R）]	Child-Pugh分级（例）
组别	例数	男	女	年龄（岁，±s）	肿瘤直径[M（Q_R）]	BMI（kg/m²，±s）	ICGR15[M（Q_R）]	A	B
FIGFI-LAH组	31	20	11	61±10	2.3（1.3）	23.6±2.8	0.062（0.052）	29	2
LAH组	39	27	12	59±9	2.3（1.5）	23.8±3.0	0.059（0.069）	34	5
统计值		χ²=0.174		t=1.072	Z=-0.373	t=-0.221	Z=0.112	χ²=0.778
P值		0.677		0.287	0.709	0.826	0.911	0.378

组别	例数	肝门阻断时间[min，M（Q_R）]	手术时间[min，M（Q_R）]	术中出血量[ml，M（Q_R）]	术后住院时间[d，M（Q_R）]
FIGFI-LAH组	31	13（20）	185（90）	200（300）	10（6）
LAH组	39	0（20）	157（76）	100（213）	12（6）
统计值		Z=1.164	Z=1.497	Z=1.747	Z=-1.497
P值		0.242	0.134	0.081	0.134
组别	例数	中转开腹（例）	手术切缘阳性（例）	术后并发症分级（例）			术后病理类型（例）
组别	例数	中转开腹（例）	手术切缘阳性（例）	Ⅰ级	Ⅱ级	Ⅲ级	肝细胞性	胆管细胞性	混合性
FIGFI-LAH组	31	1	1	28	2	1	28	2	1
LAH组	39	2	8	35	3	1	35	3	1
统计值		χ²=0.152	χ²=4.607	χ²=0.783			χ²=0.398
P值		0.696	0.032	0.676			1.000

组别	例数	肝门阻断时间[min，M（Q_R）]	手术时间[min，M（Q_R）]	术中出血量[ml，M（Q_R）]	术后住院时间[d，M（Q_R）]
FIGFI-LAH组	31	13（20）	185（90）	200（300）	10（6）
LAH组	39	0（20）	157（76）	100（213）	12（6）
统计值		Z=1.164	Z=1.497	Z=1.747	Z=-1.497
P值		0.242	0.134	0.081	0.134
组别	例数	中转开腹（例）	手术切缘阳性（例）	术后并发症分级（例）			术后病理类型（例）
组别	例数	中转开腹（例）	手术切缘阳性（例）	Ⅰ级	Ⅱ级	Ⅲ级	肝细胞性	胆管细胞性	混合性
FIGFI-LAH组	31	1	1	28	2	1	28	2	1
LAH组	39	2	8	35	3	1	35	3	1
统计值		χ²=0.152	χ²=4.607	χ²=0.783			χ²=0.398
P值		0.696	0.032	0.676			1.000

Please choose a citation manager

Content to export