Short- and Long-Term Outcomes of Indocyanine Green Fluorescence Navigation- Versus Conventional-Laparoscopic Hepatectomy for Hepatocellular Carcinoma: A Propensity Score-Matched, Retrospective, Cohort Study

Fusheng Liu, Haitao Wang, Weijie Ma, Jinghua Li, Yingyi Liu, Shengli Tang, Kun Li, Ping Jiang, Zhiyong Yang, Yueming He, Zhisu Liu, Zhonglin Zhang, Yufeng Yuan, Fusheng Liu, Haitao Wang, Weijie Ma, Jinghua Li, Yingyi Liu, Shengli Tang, Kun Li, Ping Jiang, Zhiyong Yang, Yueming He, Zhisu Liu, Zhonglin Zhang, Yufeng Yuan

Abstract

Background: Indocyanine green (ICG) fluorescence imaging technology is increasingly widely used in laparoscopic hepatectomy. However, whether it can provide long-term survival benefits to patients with liver malignancies remains unclear. This study investigated the clinical effect of laparoscopic hepatectomy for hepatocellular carcinoma (HCC) using ICG imaging technology.

Methods: We retrospectively analyzed HCC patients who underwent laparoscopic hepatectomy at Zhongnan Hospital of Wuhan University from January 2016 to December 2020. Propensity score matching (PSM) was used to match patients undergoing ICG fluorescence navigation laparoscopic hepatectomy (ICG-FNLH) with those undergoing conventional laparoscopic hepatectomy (CLH) in a 1:1 ratio to minimize the influence of confounding factors. We compared perioperative status and long-term prognosis between the two groups and performed multivariate analysis to identify risk factors associated with overall survival and recurrence-free survival.

Results: The original cohort consisted of 141 patients, with 50 patients in each group (100 patients in total) after PSM. The anatomical liver resection rate, R0 resection rate, and resection margin distance in the ICG-FNLH group were higher than those in the CLH group. The intraoperative blood loss was lower than that in the CLH group. The recurrence-free survival and overall survival of the ICG-FNLH group were better than those of the CLH group. ICG-FNLH improved the recurrence-free survival of HCC patients (hazard ratio [HR] = 2.165, 95% confidence interval [CI]: 1.136-4.127, P = 0.024).

Conclusions: Compared with CLH, ICG-FNLH can improve the recurrence-free survival rate of patients with hepatocellular carcinoma and may help to improve the long-term prognosis of patients.

Conflict of interest statement

There are no conflicts of interest for any of the authors.

© 2023. The Author(s).

Figures

Fig. 1
Fig. 1
Enrollment and conduct process
Fig 2
Fig 2
Use of ICG fluorescence-navigated laparoscopic hepatectomy. Fluorescence tumor imaging. A Fluorescence visualization helps to identify malignant nodules at the liver margins in severe cirrhosis with postoperative pathology showing hepatocellular carcinoma. B Mark the tumor boundary by fluorescence imaging during the operation; the right panel shows the liver surface visual field, conventional visual field, and the fluorescence performance of postoperative specimens. Positive fluorescent staining: C Laparoscopic transhepatic puncture (S6+part of S5), the left panel shows the portal vein branch of the target liver segment being dissected under direct vision and injected with indocyanine green (ICG); D Laparoscopic transhepatic puncture (S6), the right panel shows the intraoperative ultrasound-guided puncture of the portal vein branch of the target hepatic segment followed by injection of ICG; Negative fluorescent staining: E Fluorescence imaging of peripherally injected ICG after clamping of the left hepatic Glissonean pedicle; F Fluorescence imaging of peripheral intravenous injection of ICG after clamping the Glissonean pedicle of the right anterior lobe (S5+S8)
Fig. 3
Fig. 3
Comparison of recurrence-free survival rates and overall survival rates between the two groups before and after PSM. ICG-FNLH ICG fluorescence navigation laparoscopic hepatectomy; CLH conventional laparoscopic hepatectomy

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