Clinical Significance of Real-Time Guidance Using the ICG Fluorescent Rim on the Resection Plane During Liver...

Area of Science:

• Hepatobiliary surgery
• Surgical oncology
• Medical imaging

Background:

• Laparoscopic hepatectomy poses challenges in tumor localization due to limited palpation and ultrasound capabilities.
• Indocyanine green (ICG) fluorescence imaging offers enhanced real-time visualization for tumor detection and margin guidance.
• Assessing the clinical utility of ICG's fluorescent rim for determining resection margins in laparoscopic liver cancer surgery.

Purpose of the Study:

• To evaluate the effectiveness of real-time indocyanine green (ICG) fluorescence imaging in guiding resection margins during laparoscopic hepatectomy for malignant liver tumors.
• To determine the clinical relevance of detecting a fluorescent rim on the liver's cut surface.
• To provide technical insights for parenchymal preservation in liver resections.

Main Methods:

• Prospective evaluation of 300 patients undergoing laparoscopic hepatectomy with ICG fluorescence imaging (April 2020 - April 2023).
• Real-time ICG imaging guided surgical transection planes.
• Resection margins were adjusted based on the presence of an ICG fluorescent rim to ensure tumor clearance.

Main Results:

• A fluorescent rim was detected in 20 out of 300 patients (6.7%).
• Median tumor size was 26 mm (range: 4-52 mm).
• Median resection margin achieved was 4.5 mm (range: 0.8-10 mm), with a median postoperative hospital stay of 6 days.

Conclusions:

• Indocyanine green (ICG) fluorescence imaging is preliminarily safe and effective for guiding resection margins in laparoscopic liver resection.
• The detection of a fluorescent rim aids in achieving adequate tumor clearance.
• The technique offers valuable insights for optimizing parenchymal preservation during liver surgery.