Safety and efficacy of ICG fluorescence imaging in laparoscopic hepatectomy for primary liver cancer

doi:10.3877/cma.j.issn.2095-3232.2022.06.010

Abstract

Abstract:

Objective

To evaluate the safety and efficacy of indocyanine green (ICG) fluorescence imaging in laparoscopic hepatectomy (LH) for primary liver cancer (PLC).

Methods

Clinical data of 121 patients with PLC who underwent LH in the First Affiliated Hospital of University of Science and Technology of China from January 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, 98 patients were male and 23 female, aged from 19 to 85 years, with a median age of 56 years. According to different surgical approaches, all patients were divided into the ICG fluorescence imaging LH (FGLH) group (n=52) and LH group (n=69). Perioperative conditions and survival were compared betweentwo groups. The operation time between two groups was compared by t test. The occlusion time of porta hepatis and intraoperative blood loss were analyzed by rank-sum test. The incidence of postoperative complications was assessed by Chi-square test. Survival analysis was conducted by Kaplan-Meier method and Log-rank test.

Results

The average operation time in the FGLH group was (238±72) min, significantly shorter than (291±117) min in the LH group (t=-2.868, P<0.05). In the FGLH group, the median occlusion time of porta hepatis and intraoperative blood loss were 22(30) min and 200(200) ml, significantly less than 25(25) min and 200(300) ml in the FH group (Z=-1.997, -2.067; P<0.05). The incidence of postoperative complications in the FGLH group was 10%(5/52), significantly lower than 25%(17/69) in the LH group (χ²=4.498, P<0.05). No severe postoperative complications or perioperative death occurred in two groups. The median survival time in the FGLH and LH groups was 50.3 and 39.4 months. No significant difference was noted in the cumulative survival rate between two groups (χ²=3.196, P>0.05).

Conclusions

It is safe and effective to adopt ICG fluorescence imaging in LH, which requires short operation time, yields slight intraoperative blood loss and low incidence of postoperative complications.

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

Yu Hu, Jinliang Ma, Yongsheng Ge, Jihai Yu, Chuanhai Zhang, Wenbin Liu, Weidong Jia. Safety and efficacy of ICG fluorescence imaging in laparoscopic hepatectomy for primary liver cancer[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2022, 11(06): 580-585.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhgzwkssxdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-3232.2022.06.010

https://zhgzwkssxdzzz.cma-cmc.com.cn/EN/Y2022/V11/I06/580

Figures/Tables 4

References 20

[1]	Zhou M, Wang H, Zeng X, et al. Mortality, morbidity, and risk factors in China and its provinces，1990-2017: a systematic analysis for the Global Burden of Disease Study 2017[J]. Lancet, 2019, 394(10204):1145-1158.
[2]	中国研究型医院学会肝胆胰外科专业委员会. 腹腔镜肝切除术治疗肝细胞癌中国专家共识(2020版)[J]. 中华消化外科杂志, 2020, 19(11):1119-1134.
[3]	Ishizawa T, Kokudo N. The beginning of a new era of digestive surgery guided by fluorescence imaging[J]. Liver Cancer，2014, 3(1):6-8.
[4]	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.
[5]	Takamoto T. Improvement and development in anatomical hepatectomy for hepatocellular carcinoma[J]. Hepatobiliary Surg Nutr, 2021, 10(4):545-547.
[6]	Ishizawa T, Fukushima N, Shibahara J, et al. Real-time identifification of liver cancers by using indocyanine green fluorescent imaging[J]. Cancer, 2009, 115(11):2491-2504.
[7]	Yokoyama N, Otani T, Hashidate H, et al. Real-time detection of hepatic micrometastases from pancreatic cancer by intraoperative fluorescence imaging: preliminary results of a prospective study[J]. Cancer, 2012, 118(11):2813-2819.
[8]	Aoki T, Yasuda D, Shimizu Y, et al. Image-guided liver mapping using fluorescence navigation system with indocyanine green for anatomical hepatic resection[J]. World J Surg, 2008, 32(8):1763-1767．
[9]	Zhou Y, Lin Y, Jin HS, et al. Real-time navigation guidance using fusion indocyanine green fluorescence imaging in laparoscopic non-anatomical hepatectomy of hepatocellular carcinomas at segments 6, 7, or 8 (with videos)[J]. Med Sci Monit, 2019(25):1512-1517.
[10]	肖二卫, 陶连元, 魏艳奎, 等. 荧光腹腔镜在肝细胞癌根治性切除术中的应用[J]. 中华肝胆外科杂志, 2019, 25(2):87-89.
[11]	方驰华, 张鹏, 罗火灵, 等. 增强现实导航技术联合吲哚菁绿分子荧光影像在三维腹腔镜肝切除术中的应用[J]. 中华外科杂志, 2019, 57(8):578-584.
[12]	Lu H, Gu J, Qian XF, et al. Indocyanine green fluorescence navigation in laparoscopic hepatectomy: a retrospective single-center study of 120 cases[J]. Surg Today, 2020, 51(5):695-702.
[13]	隋明昊, 王宏光, 陈明易, 等. 吲哚菁绿荧光融合影像技术在解剖性肝切除手术中的应用[J]. 中华肝胆外科杂志，2017，23(11):754-757.
[14]	Yokoyama N, Otani T, Hashidate H, et al. Real-time detection of hepatic micrometastases from pancreatic cancer by intraoperative fluorescence imaging: preliminary results of a prospective study[J]. Cancer, 2012, 118(11):2813-2819.
[15]	蔡秀军, 蔡柳新. 腹腔镜肝切除术关键技术、难点及对策[J]. 中国实用外科杂志, 2017, 37(5):461-465．
[16]	曾思略, 曾宁, 祝文, 等. 三维可视化联合吲哚菁绿荧光影像技术在原发性肝癌诊治中的价值[J]. 南方医科大学学报, 2019, 39(12):1402-1408.
[17]	Yamamoto Y, Ikai I, Kume M, et al. New simple technique for hepatic parenchymal resection using a cavitron ultrasonic surgical aspirator and bipolar cautery equipped with a channel for water dripping[J]. World J Surg, 1999, 23(10):1032-1037.
[18]	Zhang YM, Shi R, Hou JC, et al. Liver tumor boundaries identified intraoperatively using real-time indocyanine green fluorescence imaging[J]. J Cancer Res Clin Oncol, 2017, 143(1):51-58.
[19]	Huang JW, Su WL, Wang SN. Alternative laparoscopic intracorporeal Pringle maneuver by Huang's loop[J]. World J Surg, 2018, 42(10):3312-3315.
[20]	张传海, 余继海, 马金良, 等. "改良黄氏方法"在腹腔镜肝切除第一肝门血流阻断中的应用[J]. 肝胆外科杂志, 2021, 29(5):345-349.

组别	例数	年龄（岁，±s）	性别（例）		Child-Pugh分级（例）		HBsAg阳性（例）	肿瘤直径（cm，±s）	MVI（例）
组别	例数	年龄（岁，±s）	男	女	A	B	HBsAg阳性（例）	肿瘤直径（cm，±s）	MVI（例）
FGLH组	52	56±10	44	8	41	11	37	4.4±2.3	18
LH组	69	57±12	54	15	53	16	45	5.1±2.6	10
统计值		t=-0.378	χ²=0.778		χ²=0.071		χ²=0.478	t=-1.656	χ²=0.784
P值		0.706	0.378		0.790		0.489	0.100	0.376

组别	例数	年龄（岁，±s）	性别（例）		Child-Pugh分级（例）		HBsAg阳性（例）	肿瘤直径（cm，±s）	MVI（例）
组别	例数	年龄（岁，±s）	男	女	A	B	HBsAg阳性（例）	肿瘤直径（cm，±s）	MVI（例）
FGLH组	52	56±10	44	8	41	11	37	4.4±2.3	18
LH组	69	57±12	54	15	53	16	45	5.1±2.6	10
统计值		t=-0.378	χ²=0.778		χ²=0.071		χ²=0.478	t=-1.656	χ²=0.784
P值		0.706	0.378		0.790		0.489	0.100	0.376

组别	例数	手术时间（min，±s）	术中出血量[ml，M（Q_R）]	第一肝门阻断时间[min，M（Q_R）]	术后住院时间（d，±s）	解剖性切除（例）	R0切除（例）
FGLH组	52	238±72	200（200）	22（30）	8.0±4.0	17	49
LH组	69	291±117	200（300）	25（25）	8.2±3.5	18	64
统计值		t=-2.868	Z=-2.067	Z=-1.997	Z=-0.341	χ²=1.436	0
P值		0.005	0.039	0.046	0.733	0.231	1.000

组别	例数	手术时间（min，±s）	术中出血量[ml，M（Q_R）]	第一肝门阻断时间[min，M（Q_R）]	术后住院时间（d，±s）	解剖性切除（例）	R0切除（例）
FGLH组	52	238±72	200（200）	22（30）	8.0±4.0	17	49
LH组	69	291±117	200（300）	25（25）	8.2±3.5	18	64
统计值		t=-2.868	Z=-2.067	Z=-1.997	Z=-0.341	χ²=1.436	0
P值		0.005	0.039	0.046	0.733	0.231	1.000

Please choose a citation manager

Content to export