Determination of surgical margins in laparoscopic parenchyma-sparing hepatectomy of neuroendocrine tumors liver metastases using indocyanine green fluorescence imaging

Wang, Gaoming; Luo, Ying; Qi, Wei-Jun; Yuan, Chunhui; Xiu, Dianrong

doi:10.1007/s00464-021-08791-6

Cited by 8 publications

(13 citation statements)

References 25 publications

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“…3 ). In the liver metastases group, two studies [ 26 , 28 ] reported an R0 resection rate of 98.2% (111/113) in the ICG group and 86.5% (45/52) in the non-ICG group, with moderate heterogeneity observed ( I 2 = 64%, P = 0.09). The ICG group showed a nonsignificant increase in the R0 resection rate (OR = 5.26, 95% CI 0.25-110.87, P = 0.29) (Fig.…”

Section: Resultsmentioning

confidence: 99%

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Surgical margin status outcome of intraoperative indocyanine green fluorescence-guided laparoscopic hepatectomy in liver malignancy: a systematic review and meta-analysis

Tangsirapat,

Kengsakul,

Udomkarnjananun

et al. 2024

BMC Surg

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Background Hepatectomy stands as a curative management for liver cancer. The critical factor for minimizing recurrence rate and enhancing overall survival of liver malignancy is to attain a negative margin hepatic resection. Recently, Indocyanine green (ICG) fluorescence imaging has been proven implemental in aiding laparoscopic liver resection, enabling real-time tumor identification and precise liver segmentation. The purpose of this study is to conduct a systematic review and meta-analysis to ascertain whether ICG-guided laparoscopic hepatectomy yields a higher incidence of complete tumor eradication (R0) resections. Methods The search encompassed databases such as PubMed, Cochrane Library database, Scopus, ScienceDirect, and Ovid in April 2024, in strict adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies involving patients with malignant liver lesions who underwent ICG-guided laparoscopic hepatectomy and reported R0 resection outcomes were eligible for inclusion in this review. Results In a total of seven studies, involving 598 patients, were included in the meta-analysis. The ICG demonstrated a significantly elevated R0 resection rate compared to the non-ICG group [98.6% (359/364) vs. 93.1% (339/364), odds ratio (OR) = 3.76, 95% confidence intervals (CI) 1.45–9.51, P = 0.005]. Notably, no heterogeneity was observed (I2 = 0%, P = 0.5). However, the subtype analysis focusing on hepatocellular carcinoma [98.2% (165/168) vs. 93.6% (161/172), OR = 3.34, 95% CI 0.94–11.91, P = 0.06) and the evaluation of margin distance (4.96 ± 2.41 vs. 2.79 ± 1.92 millimeters, weighted mean difference = 1.26, 95% CI -1.8-4.32, P = 0.42) revealed no apparent differences. Additionally, the incidence of overall postoperative complications was comparable between both groups, 27.6% (66/239) in the ICG group and 25.4% (75/295) in the non-ICG group (OR = 0.96, 95% CI 0.53–1.76, P = 0.9). No disparities were identified in operative time, intraoperative blood loss, postoperative blood transfusion, and length of hospital stay after the surgery. Conclusions The implementation of ICG-guided laparoscopic hepatectomy can be undertaken with confidence, as it does not compromise either intraoperative or postoperative events. Furthermore, the ICG-guided approach is beneficial to achieving a complete eradication of the tumor during hepatic resection. Trial registration PROSPERO registration number CRD42023446440.

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Section: Resultsmentioning

confidence: 99%

“…Postoperative blood transfusion rates were reported in five studies [ 26 – 30 ]: 11.6% (23/198) in the ICG group and 15.9% (31/195) in the non-ICG group. No significant heterogeneity was observed ( I 2 = 0%, P = 0.78).…”

Section: Resultsmentioning

confidence: 99%

Surgical margin status outcome of intraoperative indocyanine green fluorescence-guided laparoscopic hepatectomy in liver malignancy: a systematic review and meta-analysis

Tangsirapat,

Kengsakul,

Udomkarnjananun

et al. 2024

BMC Surg

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“…10 studies ( 21 – 25 , 27 , 28 , 31 , 32 , 34 ) including 944 patients reported the R0 resection rate, there was no heterogeneity between the two groups ( p = 0.52, I 2 = 0%), and fixed-effects model analysis was used. The meta-analysis results showed that the R0 resection rate of the FMI group was significantly higher than that of the conventional group (OR = 2.63; 95% CI: 1.46~4.73, p = 0.001) ( Figure 3 ).…”

Section: Resultsmentioning

confidence: 99%

“…10 studies ( 21 – 26 , 28 – 31 , 33 ) including 910 patients reported the complications of grade III or above, there was no heterogeneity between the two groups too ( p = 0.55, I 2 = 0%), and fixed-effects model analysis was used. The results of meta-analysis showed that there was no significant difference in the complications of grade III rate between the two groups (OR = 0.73; 95% CI: 0.43~1.25, p = 0.26) ( Figure 5 ).…”

Section: Resultsmentioning

confidence: 99%

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

Zhu¹,

Qiu²,

Zeng³

et al. 2023

Front. Oncol.

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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.

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“…Experience with minimally invasive liver surgery in NELM has only scarcely been described in the literature [ 32 , 33 ]. To the best of our knowledge, only one study has compared MILS with OLS in NELM patients in terms of oncological outcome so far [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Surgical Approach to Liver Metastases in GEP-NET in a Tertiary Reference Center

Butz

Dukaczewska

Jann

et al. 2023

Cancers

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Indications for liver resection in patients with gastroenteropancreatic neuroendocrine tumors (GEP-NET) vary from liver resection with curative intent to tumor debulking or tissue sampling for histopathological characterization. With increasing expertise, the number of minimally invasive liver surgeries (MILS) in GEP-NET patients has increased. However, the influence on the oncological outcome has hardly been described. The clinicopathological data of patients who underwent liver resection for hepatic metastases of GEP-NET at the Department of Surgery, Charité—Universitätsmedizin Berlin, were analyzed. Propensity score matching (PSM) was performed to compare MILS with open liver surgery (OLS). In total, 22 patients underwent liver surgery with curative intent, and 30 debulking surgeries were analyzed. Disease-free survival (DFS) was longer than progression-free survival (PFS) (10 vs. 24 months), whereas overall survival (OS) did not differ significantly (p = 0.588). Thirty-nine (75%) liver resections were performed as OLS, and thirteen (25%) as MILS. After PSM, a shorter length of hospital stay was found for the MILS group (14 vs. 10 d, p = 0.034), while neither DFS/PFS nor OS differed significantly. Both curative intended and cytoreductive resection of hepatic GEP-NET metastases achieved excellent outcomes. MILS led to a reduced length of hospital, while preserving a good oncological outcome.

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Determination of surgical margins in laparoscopic parenchyma-sparing hepatectomy of neuroendocrine tumors liver metastases using indocyanine green fluorescence imaging

Cited by 8 publications

References 25 publications

Surgical margin status outcome of intraoperative indocyanine green fluorescence-guided laparoscopic hepatectomy in liver malignancy: a systematic review and meta-analysis

Surgical margin status outcome of intraoperative indocyanine green fluorescence-guided laparoscopic hepatectomy in liver malignancy: a systematic review and meta-analysis

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

Surgical Approach to Liver Metastases in GEP-NET in a Tertiary Reference Center

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