To explore the application value of indocyanine green (ICG) fluorescence imaging navigation in repeat laparoscopic hepatectomy for recurrent liver cancer.

Clinical data of 10 patients with recurrent liver cancer who underwent repeat laparoscopic hepatectomy in West China Hospital from January 2018 to April 2019 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 9 patients were male and 1 female, aged 48-83 years old with a median age of 62 years old. Before operation, all patients were with Child-Pugh grade A liver function. Laparoscopic hepatectomy was performed with ICG fluorescence imaging navigation. ICG (0.5 mg/kg) was injected in the peripheral vein at preoperative 3-14 d. Intraoperatively, ICG fluorescence imaging was utilized to determine the tumor location. The liver parenchyma was resected at 1-2 cm from the tumor margin.

All patients underwent laparoscopic hepatectomy successfully without conversion to open surgery. All tumors were radically resected. Among them, 1 case underwent right hepatectomy, 1 case of left hepatectomy, 1 case of mesohepatectomy, 2 cases of left lateral hepatectomy, 1 case of left lateral hepatectomy + partial hepatectomy of the right lobe and 4 cases of partial hepatectomy, respectively. No perioperative death occurred. The median intraoperative blood loss was 75(20-500) ml. Only one patient received intraoperative blood transfusion.One patient developed pulmonary infection after operation. No postoperative complications, such as bile leakage and liver failure, were observed. The length of postoperative hospital stay was 5(2-11) d. All patients were discharged. Postoperative follow-up time was 1-14 months with a median follow-up time of 9 months. All patients survived during the postoperative follow-up. One patient recurred at 9 months after surgery. No recurrence or metastasis was noted in the remaining cases.

ICG fluorescence imaging navigation is safe and effective when applied in repeat laparoscopic hepatectomy for recurrent liver cancer, which has multiple advantages regarding minimal invasiveness, visualization and precision.