Application value of fusion indocyanine green fluorescence imaging in the laparoscopic anatomical liver resection

Abstract

Objective To investigate the application value of fusion indocyanine green fluorescence imaging (FIGFI) in the laparoscopic anatomical liver resection (ALR). Methods The retrospective cross-sectional study was conducted. The clinical data of 21 patients who underwent laparoscopic ALR using FIGFI in the Chinese People′s Liberation Army General Hospital between December 2015 and February 2017 were collected. Indocyanine green (ICG) staining included positive staining and negative staining. Observation indicators: (1) intraoperative situations: surgical procedures, extent of liver resection, methods and results of ICG staining, operation time, volume of intraoperative blood loss, cases with blood transfusion; (2) postoperative situations: postoperative complications, duration of postoperative hospital stay, postoperative pathological examination; (3) follow-up situations. Follow-up using outpatient examination and telephone interview was performed to detect the patients′ survival and tumor recurrence or metastasis up to March 2017. Measurement data with normal distribution were represented as average (range). Results (1) Intraoperative situations: of 21 patients, 20 underwent successful laparoscopic ALR and 1 had conversion to open surgery. The positive and negative stainings of ICG were respectively applied to 5 and 16 patients. Seventeen patients had successful staining and 4 had failed staining. Average operation time, average volume of intraoperative blood loss and cases with blood transfusion were respectively 268 minutes (range, 120-360 minutes), 388 mL (range, 100-800 mL) and 3. (2) Postoperative situations: 5 patients had postoperative complications, including 3 with Clavien-Dindo classification I and 2 with Clavien-Dindo classification II. Average duration of postoperative hospital stay of 21 patients was 9.3 days (range, 6.0-14.0 days). Sixteen patients with malignant tumor had negative surgical margins. (3) Follow-up situations: all the 21 patients were followed up for 1.0-14.0 months, with a median time of 3.3 months. During follow-up, all the patients survived, and 1 patient had tumor recurrence. Conclusion The FIGFI is safe and feasible in the laparoscopic ALR, with a good short-term outcome. Key words: Liver neoplasms; Carcinoma, hepatocellular; Hepatectomy, anatomy; Indocyanine green fluorescence imaging; Laparoscopy