Journal of Surgery Concepts & Practice >

2025 , Vol. 30 >Issue 04: 325 - 331

DOI: https://doi.org/10.16139/j.1007-9610.2025.04.06

Original article

Assessment of indocyanine green fluorescence imaging in hepatectomy for primary liver carcinoma: short-term prognostic analysis

  • HUANG Wenxin ,
  • HE Qining ,
  • Qi Debin ,
  • Cao Zichao ,
  • JIANG Yanzhi ,
  • WANG Pusen ,
  • QUE Weitao ,
  • ZHONG Lin
Expand
  • 1. Department of Hepatobiliary Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
    2a. Department of Gastroenterology, b. Department of Liver Surgery (Liver Transplantation), the Third People's Hospital of Shenzhen, Guangdong Shenzhen 518112, China

Received date: 2024-10-12

  Online published: 2025-10-23

Fold

Abstract

Objective To explore the efficiency of indocyanine green (ICG) fluorescence imaging-guided hepatectomy and its short-term prognosis in patients with primary liver carcinoma. Methods Retrospective analysis was conducted on 166 patients diagnosed with primary liver carcinoma and admitted to the Department of Hepatobiliary Surgery of Shanghai General Hospital affiliated to Shanghai Jiao Tong University School of Medicine from June 2018 to June 2021. Patients were categorized into ICG group (n=72) and non-ICG group (n=94) based on the utilization of ICG during surgery. Moreover, the clinical information of preoperation, intraoperation, and postoperation were collected and compared between the two groups. ICG fluorescence images of the lesions in the ICG group were recorded for analysis. Results ICG fluorescence intensity is associated with the histopathology, differentiation grade of primary liver cancer, and the presence of liver cirrhosis. Hepatocellular carcinoma lesions predominantly displayed partial fluorescence, while intrahepatic cholangiocarcinoma lesions showed circular fluorescence. Well differentiated tumors exhibited complete fluorescence (7/11), moderately differentiated tumors demonstrated partial fluorescence (28/51), and poorly differentiated tumors displayed circular fluorescence (7/10). Most patients with liver cirrhosis exhibited partial fluorescence (18/35) or complete fluorescence (13/35).Compared to the non-ICG group, the ICG group demonstrated higher serum albumin levels on the first (34.6 g/L vs. 31.4 g/L) and the third postoperative days (32.4 g/L vs. 31.2 g/L)(P<0.001). Conversely, the ICG group showed shorter operation time (170 min vs. 210 min), lower rate of intraoperative hepatic portal blockade (9.7% vs. 33.0%), less intraoperative blood loss (400 mL vs. 430 mL), shorter postoperative hospital stay (10 d vs. 14 d), and lower incidence of short-term postoperative complications (4.2% vs. 20.2%) (P<0.05) compared to the non-ICG group. Conclusions ICG fluorescence intensity is associated with the histopathology, differentiation grade of primary liver cancer, and the presence of liver cirrhosis.The judicious application of ICG fluorescence imaging technology alongside surgical techniques holds promise for improving short-term prognosis and expediting the postoperative recovery.

Key words： Primary liver carcinoma; Indocyanine green(ICG); Fluorescence image; Hepatectomy

Cite this article

HUANG Wenxin , HE Qining , Qi Debin , Cao Zichao , JIANG Yanzhi , WANG Pusen , QUE Weitao , ZHONG Lin . Assessment of indocyanine green fluorescence imaging in hepatectomy for primary liver carcinoma: short-term prognostic analysis[J]. Journal of Surgery Concepts & Practice, 2025 , 30(04) : 325 -331 . DOI: 10.16139/j.1007-9610.2025.04.06

References

[1] RUMGAY H, ARNOLD M, FERLAY J, et al. Global burden of primary liver cancer in 2020 and predictions to 2040[J]. J Hepatol, 2022, 77(6):1598-1606.
[2] SUNG H, FERLAY J, SIEGEL R L, et al. Global cancer statistics 2020:GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2021, 71(3):209-249.
[3] CHEN W, ZHENG R, BAADE P D, et al. Cancer statistics in China, 2015[J]. CA Cancer J Clin, 2016, 66(2):115-132.
[4] European Association for the Study of the Liver. EASL clinical practice guidelines:management of hepatocellular carcinoma[J]. J Hepatol, 2018, 69(1):182-236.
[5] LLOVET J M, DE BAERE T, KULIK L, et al. Locoregional therapies in the era of molecular and immune treatments for hepatocellular carcinoma[J]. Nat Rev Gastroenterol Hepatol, 2021, 18(5):293-313.
[6] MA?IANSKIEN? R, ALMANAITYT? M, TREINYS R, et al. Spectral characteristics of voltage-sensitive indocyanine green fluorescence in the heart[J]. Sci Rep, 2017, 7(1):7983.
[7] EGLOFF-JURAS C, BEZDETNAYA L, DOLIVET G, et al. NIR fluorescence-guided tumor surgery:new strategies for the use of indocyanine green[J]. Int J Nanomedicine, 2019,14:7823-7838.
[8] KOKUDO N. Indocyanine green fluorescence imaging as an indispensable tool for modern liver surgery[J]. Ann Surg, 2022, 275(6):1035-1036.
[9] 骆洋, 俞旻皓, 叶光耀, 等. 术中吲哚菁绿荧光显像评估在降低腹腔镜直肠癌术后吻合口漏的应用价值[J]. 外科理论与实践, 2023, 28(3):249-253.
  LUO Y, YU M H, YE G Y, et al. Application value of intraoperative indocyanine green fluorescence imaging in reducing anastomotic leakage after laparoscopic rectal cancer surgery[J]. J Surg Concepts Pract, 2019, 28(3):249-253.
[10] CHEN Q Y, XIE J W, ZHONG Q, et al. Safety and efficacy of indocyanine green tracer-guided lymph node dissection during laparoscopic radical gastrectomy in patients with gastric cancer:a randomized clinical trial[J]. JAMA surgery, 2020, 155(4):300-311.
[11] WANG X, TEH C S C, ISHIZAWA T, et al. Consensus guidelines for the use of fluorescence imaging in hepatobiliary surgery[J]. Ann Surg, 2021, 274(1):97-106.
[12] HSU A, MU S Z, JAMES A, et al. Indocyanine green in bariatric surgery:a systematic review[J]. Obes Surg, 2023, 33(11):3539-3544.
[13] HAN H W, SHI N, ZOU Y P, et al. Functional anatomical hepatectomy guided by indocyanine green fluorescence imaging in patients with localized cholestasis:report of four cases[J]. World J Gastrointest Surg, 2021, 13(3):323-329.
[14] ALFANO M S, MOLFINO S, BENEDICENTI S, et al. Intraoperative ICG-based imaging of liver neoplasms:a simple yet powerful tool. Preliminary results[J]. Surg Endosc, 2019, 33(1):126-134.
[15] WAKABAYASHI T, CACCIAGUERRA A B, ABE Y, et al. Indocyanine green fluorescence navigation in liver surgery:a systematic review on dose and timing of administration[J]. Ann Surg, 2022, 275(6):1025-1034.
[16] SPERBER A D, BANGDIWALA S I, DROSSMAN D A, et al. Worldwide prevalence and burden of functional gastrointestinal disorders, results of rome foundation global study[J]. Gastroenterology, 2021, 160(1):99-114.e3.
[17] LU C, RONG D, ZHANG B, et al. Current perspectives on the immunosuppressive tumor microenvironment in hepatocellular carcinoma:challenges and opportunities[J]. Mol Cancer, 2019, 18(1):130.
[18] DAI Y, QIANG W, LIN K, et al. An immune-related gene signature for predicting survival and immunotherapy efficacy in hepatocellular carcinoma[J]. Cancer Immunol Immunother, 2021, 70(4):967-979.
[19] WATANABE J, TAKEMASA I, KOTAKE M, et al. Blood perfusion assessment by indocyanine green fluorescence imaging for minimally invasive rectal cancer surgery (EssentiAL trial):a randomized clinical trial[J]. Ann Surg, 2023, 278(4):e688-e694.
[20] DUROT I, WILSON S R, WILLMANN J K. Contrast-enhanced ultrasound of malignant liver lesions[J]. Abdom Radiol (NY), 2018, 43(4):819-847.
[21] NAKASEKO Y, ISHIZAWA T, SAIURA A. Fluorescence-guided surgery for liver tumors[J]. J Surg Oncol, 2018, 118(2):324-331.
[22] CASSINOTTI E, AL-TAHER M, ANTONIOU S A, et al. European association for endoscopic surgery (EAES) consensus on indocyanine green (ICG) fluorescence-guided surgery[J]. Surg Endosc, 2023, 37(3):1629-1648.
[23] TANG Y, HUANG Z, ZHANG X, et al. Effect of visceral obesity on outcomes of fluorescence-guided lymphadenectomy during laparoscopic gastrectomy for gastric cancer:Post hoc analysis of a randomized phase 3 trial[J]. Chin J Cancer Res, 2024, 36(5):503-516.
[24] CHEN Q Y, ZHONG Q, LIU Z Y, et al. Indocyanine green fluorescence imaging-guided versus conventional laparoscopic lymphadenectomy for gastric cancer:long-term outcomes of a phase 3 randomised clinical trial[J]. Nat Commun, 2023, 14(1):7413.
[25] 周煦川, 刘宾, 王文飞, 等. 多点注射吲哚菁绿红外显影在下肢淋巴管-静脉吻合术中的应用[J]. 组织工程与重建外科杂志, 2023, 19(5):459-463
  ZHOU X C, LIU B, WANG W F, et al. Application of multi-point injection of indocyanine green infrared imaging in lymphangio-venous anastomosis of lower extremities[J]. J Tissue Eng Reconstr Surg, 2019, 19(5):459-463.
[26] RUZZENENTE A, CONCI S, ISA G, et al. The LIver SEntinel LYmph-node (LISELY) study:a prospective intraoperative real time evaluation of liver lymphatic drainage and sentinel lymph-node using near-infrared (NIR) imaging with indocyanine green (ICG)[J]. Eur J Surg Oncol, 2022, 48(12):2455-2459.
[27] WU M R, HUANG Y Y, HSIAO J K. Use of indocyanine green (ICG), a medical near infrared dye, for enhanced fluorescent imaging-comparison of organic anion transporting polypeptide 1B3 (OATP1B3) and sodium-taurocholate cotransporting polypeptide (NTCP) reporter genes[J]. Molecules, 2019, 24(12):2295.
[28] ANZAI K, TSURUYA K, MORIMACHI M, et al. The impact of a heterozygous SLCO1B3 null variant on the indocyanine green retention test[J]. J Pharm Sci, 2020, 109(10):3206-3209.
[29] ISHIZAWA T, SAIURA A, KOKUDO N. Clinical application of indocyanine green-fluorescence imaging during hepatectomy[J]. Hepatobiliary Surg Nutr, 2016, 5(4):322-328.
[30] FENG H L, LI Q, WANG L, et al. Indocyanine green clearance test combined with MELD score in predicting the short-term prognosis of patients with acute liver fai-lure[J]. Hepatobiliary Pancreat Dis Int, 2014, 13(3):271-275.
Options
Outlines

/

〈 〉