Application of indocyanine green-mediated fluorescence molecular imaging technology in liver tumors resection: a systematic review and meta-analysis

Abstract

BackgroundThis meta-analysis was dedicated to evaluating the safety and effectiveness of indocyanine green (ICG) -mediated fluorescence molecular imaging (FMI) technology in liver tumors resection.MethodsA literature search of PubMed, Embase databases, Cochrane Library, and Web of Science was performed to identify all clinical controlled studies exploring the effects of fluorescence imaging on liver tumors resection. Quality assessment and data extraction of studies were conducted independently by 3 reviewers. Mean difference (MD) and odds ratio (OR) with 95% confidence interval (CI) were calculated using a fixed-effects or random-effects model. The meta-analysis was performed with RevMan 5.3 software.Results14 retrospective cohort studies (RCSs) involving a total of 1227 patients were finally included. The results showed that Fluorescence-assisted liver tumors resection could improve the R0 resection rate (OR = 2.63; 95% CI: 1.46~4.73, p = 0.001), reduce overall complications (OR = 0.66; 95% CI: 0.44~0.97, p = 0.04), biliary fistula (OR = 0.20; 95% CI: 0.05~0.77, p = 0.02), intraoperative blood loss (MD = −70.76, 95% CI: −106.11 to −35.41; p < 0.0001), and shortens hospital stay (MD = −1.41, 95% CI: −1.90 to −0.92; p < 0.00001). There were no significant differences in the incidences of operative time (MD = −8.68, 95% CI: −18.59 to −1.22; p = 0.09), complications of grade III or above (OR = 0.73; 95% CI: 0.43~1.25, p = 0.26), liver failure (OR = 0.86; 95% CI: 0.39~1.89, p = 0.71), and blood transfusion (OR = 0.66; 95% CI: 0.42~1.03, p = 0.07).ConclusionCurrent evidence suggests that ICG-mediated FMI technology could enhance the clinical effectiveness of patients with liver tumors resection and is clinically worthy of promotion.Systematic review registrationPROSPERO, identifier CRD42022368387.

Application of Indocyanine Green Fluorescence Imaging for Tumor Localization during Robot-Assisted Hepatectomy

“…However, combining ICG fluorescence imaging with conventional modalities may facilitate clearer and easier tumor identification, leading to more curative treatments. In fact, a recent meta-analysis revealed that ICG fluorescence-guided open or laparoscopic hepatectomy improved the R0 resection rate [16]. Despite its limitations, ICG fluorescence imaging is an easy and useful technique for tumor identification.…”

“…In the field of hepatobiliary surgery, this technique can be used for bile duct visualization, tumor localization, and hepatic segmentation [5][6][7][10][11][12]. Previous studies have assessed the usefulness of ICG fluorescence imaging in hepatobiliary surgery [13][14][15][16][17]. In particular, due to poorer palpation and ease of use, the visualization of hepatic tumors is a more efficient technique in laparoscopic hepatectomy than in open hepatectomy [18].…”