Retrospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jan 27, 2025; 17(1): 101793
Published online Jan 27, 2025. doi: 10.4240/wjgs.v17.i1.101793
Laparoscopic hepatectomy using indocyanine green attenuates postoperative inflammatory response for hepatocellular carcinoma: A propensity score matching analysis
Wei-Xun Wu, Ming-Bin Huang, Mei-Xia Wang, Li-Hua Chen, Bo Hu, Zhen-Bin Ding
Wei-Xun Wu, Ming-Bin Huang, Li-Hua Chen, Bo Hu, Department of Liver Surgery, Zhongshan Hospital (Xiamen), Fudan University, Xiamen 361006, Fujian Province, China
Mei-Xia Wang, Department of Infection Management, Zhongshan Hospital (Xiamen), Fudan University, Xiamen 361015, Fujian Province, China
Zhen-Bin Ding, Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai 200032, China
Zhen-Bin Ding, Key Laboratory of Carcinogenesis and Cancer Invasion (Ministry of Education), Fudan University, Shanghai 200032, China
Co-first authors: Wei-Xun Wu and Ming-Bin Huang.
Co-corresponding authors: Bo Hu and Zhen-Bin Ding.
Author contributions: Wu WX and Huang MB contribute equally to this study as co-first authors; Hu B and Ding ZB contribute equally to this study as co-corresponding authors; Wu WX, Hu B and Ding ZB participated in the conception and design of the study; Huang MB, Wang MX and Chen LH were involved in the acquisition, analysis, or interpretation of data; Huang MB wrote the manuscript; Hu B and Ding ZB accessed and verified the study data; all authors critically reviewed and provided final approval of the manuscript; all authors were responsible for the decision to submit the manuscript for publication.
Supported by the Incubation Project of Zhongshan Hospital (Xiamen), Fudan University, No. 2019ZSXMYS15; the Clinical Research Center for Precision Medicine of Abdominal Tumor of Fujian Province; the Key Clinical Specialty Discipline Construction Program of Fujian Province; and Xiamen Medical and Health Guidance Project, No. 3502Z20244ZD1103.
Institutional review board statement: The study was reviewed and approved by the ethics committee of Zhongshan Hospital (Xiamen), Fudan University (No. B2024-047R).
Informed consent statement: The need for patient consent was waived due to the retrospective nature of the study.
Conflict-of-interest statement: The authors have no conflicts of interest or disclosures to report.
Data sharing statement: The datasets generated during and/or analyzed during the current study are available from the corresponding author upon reasonable request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zhen-Bin Ding, Doctor, PhD, Professor, Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai 200032, China. ding.zhenbin@zs-hospital.sh.cn
Received: September 27, 2024
Revised: November 11, 2024
Accepted: December 2, 2024
Published online: January 27, 2025
Processing time: 91 Days and 9.2 Hours
Abstract
BACKGROUND

Improving the intraoperative and postoperative performance of laparoscopic hepatectomy was quite a challenge for liver surgeons.

AIM

To determine the benefits of indocyanine green (ICG) fluorescence imaging in patients with hepatocellular carcinoma (HCC) who underwent laparoscopic hepatectomy during and after surgery.

METHODS

We retrospectively collected the clinicopathological data of 107 patients who successfully underwent laparoscopic hepatectomy at Zhongshan Hospital (Xiamen), Fudan University from June 2022 to June 2023. Whether using the ICG fluorescence imaging technique, we divided them into the ICG and non-ICG groups. To eliminate statistical bias, a 1:1 propensity score matching analysis was conducted. The comparison of perioperative outcomes, including inflammation-related markers and progression-free survival, was analyzed statistically.

RESULTS

Intraoperatively, the ICG group exhibited lower blood loss, a shorter surgical time, lower hepatic inflow occlusion (HIO) frequency, and a shorter total HIO time. Postoperatively, the participation of ICG resulted in a shorter duration of hospitalization (6.5 vs 7.6 days, P = 0.03) and postoperative inflammatory response attenuation (lower neutrophil-lymphocyte ratio on the first day after surgery and platelet-lymphocyte ratio on the third day, P < 0.05). Although the differences were not significant, the levels of all inflammation-related markers were lower in the ICG group. The rates of postoperative complications and the survival analyses, including progression-free and overall survivals showed no significant difference between the groups.

CONCLUSION

The involvement of ICG fluorescence imaging may lead to improved perioperative outcomes, especially postoperative inflammatory response attenuation, and ultimately improve HCC patients’ recovery after surgery.

Keywords: Hepatocellular carcinoma; Laparoscopic hepatectomy; Indocyanine green fluorescence; Postoperative inflammatory response attenuation; Propensity score matching analysis

Core Tip: This study aimed to determine the benefits of indocyanine green (ICG) fluorescence imaging in patients with hepatocellular carcinoma (HCC) who underwent laparoscopic hepatectomy. Compared with solitary laparoscopic hepatectomy, laparoscopic hepatectomy using ICG fluorescence imaging resulted in lower blood loss, a shorter surgical time, lower hepatic inflow occlusion (HIO) frequency, and a shorter total HIO time during surgery. Postoperatively, the participation of ICG resulted in a shorter duration of hospitalization and postoperative inflammatory response attenuation. The involvement of ICG fluorescence imaging may lead to better perioperative outcomes, especially postoperative inflammatory response attenuation, and ultimately improve HCC patients’ recovery after surgery.