To systematically evaluate the safety and efficacy of indocyanine green (ICG) fluorescence imaging-guided laparoscopic hepatectomy (FIGLTR).

Relevant clinical studies published before July 21, 2024 were systematically searched from PubMed, Web of Science, Embase, CNKI, Wanfang Data and Chongqing VIP databases. The searching keywords included indocyanine green, fluorescence imaging, laparoscopic, hepatectomy, liver cancer and liver tumor. Clinical data were extracted after evaluating the quality of included studies. The overall results were subject to meta-analysis using Review Manager 5.4 software. The comprehensive effect was evaluated by fixed effect or random effect models. The publication bias was assessed by funnel chart. The asymmetry of funnel chart was assessed by Begg test and/or Egger test.

In this meta-analysis, 28 retrospective cohort studies and 4 RCTs were included, comprising 2 630 patients including 1 386 in the non-FIGLTR group and 1 244 in the FIGLTR group. Meta-analysis showed that operation time (MD=12.60, 95%CI: 2.99-22.21), intraoperative blood loss (MD=52.19, 95%CI: 32.41-71.96), blood transfusion rate (OR=1.90, 95%CI: 1.17-3.09), R0 resection rate (OR=0.38, 95%CI: 0.24-0.62), overall incidence of postoperative complications (OR=1.61, 95%CI: 1.30-2.00) and the length of postoperative hospital stay (MD=0.86, 95%CI: 0.21-1.52) in the non-FLIGLTR group were significantly increased than those in the FIGLTR group (all P<0.05). However, no statistical significance was observed in the hepatic portal occlusion time (MD=-0.92, 95%CI: -4.64-2.80), the minimum resection margin width (MD=-3.12, 95%CI: -9.61-3.37) and the total length of hospital stay (MD=-0.18, 95%CI: -2.85-2.50) (all P>0.05). Sensitivity analysis and funnel chart analysis confirmed that the results of meta-analysis were stable and reliable.

Meta-analysis demonstrates that FIGLTR can improve the R0 resection rate of patients with liver cancer without affecting the minimum resection margin width. It yields higher safety, faster recovery and lower incidence of complications compared with non-FIGLTR.