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Peer-reviewedCC BY-NCAnnals of surgical treatment and research

Prognostic significance of indocyanine green fluorescence patterns in resected hepatocellular carcinoma: a retrospective analysis of prospectively collected data.

  • Hyo-Won Ahn1,2
  • Hyun Soo Kang1,2
  • Gayoung Kim1,2
  • Min Kyoung Kim1,2
  • Sang Hyuk Park1,2
  • Jae-Yoon Kim1,2
  • Su Young Hong1,2
  • YoungRok Choi1,2
  • Kwang-Woong Lee1,2
  • Suk Kyun Hong1,2
  1. 1Department of Surgery, Seoul National University Hospital, Seoul, Korea.
  2. 2Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
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Abstract

Purpose

Indocyanine green (ICG) fluorescence imaging enables intraoperative visualization of liver tumors and reflects distinct tumor biology according to uptake patterns. However, its prognostic significance in hepatocellular carcinoma (HCC), particularly in relation to resection margins, remains unclear. This study evaluated the impact of ICG fluorescence patterns on recurrence-free survival (RFS) after curative resection for HCC.Methods

We retrospectively analyzed prospectively collected data from 66 patients who underwent HCC resection with intraoperative ICG fluorescence assessment between September 2021 and December 2023.Results

ICG patterns were classified as total uptake (n = 8), partial uptake (n = 41), or rim enhancement (n = 17). Rim enhancement was associated with significantly higher early recurrence rates (47.1% vs. 12.2% vs. 0%, P = 0.003) and shorter RFS (13.6 months vs. 17.1 months vs. 22.8 months, P = 0.003). On multivariate analysis, rim enhancement (hazard ratio [HR], 7.18; P < 0.001), resection margin ≤2 mm (HR, 3.67; P = 0.011), and multiple tumors (HR, 5.16; P = 0.005) independently predicted poorer RFS. Among patients with rim enhancement, narrow margins and microvascular invasion were strongly associated with early recurrence.Conclusion

ICG fluorescence patterns provide prognostic information in HCC. Rim enhancement identifies high-risk tumors and may guide intraoperative decisions to achieve wider resection margins and improve oncologic outcomes.

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Cite

BibTeXRIS
BibTeX
@article{ahn2026prognostic,
  title = {{Prognostic significance of indocyanine green fluorescence patterns in resected hepatocellular carcinoma: a retrospective analysis of prospectively collected data.}},
  author = {Hyo-Won Ahn and Hyun Soo Kang and Gayoung Kim and Min Kyoung Kim and Sang Hyuk Park and Jae-Yoon Kim and Su Young Hong and YoungRok Choi and Kwang-Woong Lee and Suk Kyun Hong},
  journal = {Annals of surgical treatment and research},
  year = {2026},
  month = oct,
  doi = {10.4174/astr.2026.111.4.194},
  url = {https://europepmc.org/article/MED/42909238},
  note = {CC BY-NC},
}
RIS
TY  - JOUR
TI  - Prognostic significance of indocyanine green fluorescence patterns in resected hepatocellular carcinoma: a retrospective analysis of prospectively collected data.
AU  - Hyo-Won Ahn
AU  - Hyun Soo Kang
AU  - Gayoung Kim
AU  - Min Kyoung Kim
AU  - Sang Hyuk Park
AU  - Jae-Yoon Kim
AU  - Su Young Hong
AU  - YoungRok Choi
AU  - Kwang-Woong Lee
AU  - Suk Kyun Hong
PY  - 2026
DA  - 2026/10/08
JO  - Annals of surgical treatment and research
DO  - 10.4174/astr.2026.111.4.194
UR  - https://europepmc.org/article/MED/42909238
AB  - Purpose  Indocyanine green (ICG) fluorescence imaging enables intraoperative visualization of liver tumors and reflects distinct tumor biology according to uptake patterns. However, its prognostic significance in hepatocellular carcinoma (HCC), particularly in relation to resection margins, remains unclear. This study evaluated the impact of ICG fluorescence patterns on recurrence-free survival (RFS) after curative resection for HCC.Methods  We retrospectively analyzed prospectively collected data from 66 patients who underwent HCC resection with intraoperative ICG fluorescence assessment between September 2021 and December 2023.Results  ICG patterns were classified as total uptake (n = 8), partial uptake (n = 41), or rim enhancement (n = 17). Rim enhancement was associated with significantly higher early recurrence rates (47.1% vs. 12.2% vs. 0%, P = 0.003) and shorter RFS (13.6 months vs. 17.1 months vs. 22.8 months, P = 0.003). On multivariate analysis, rim enhancement (hazard ratio [HR], 7.18; P < 0.001), resection margin ≤2 mm (HR, 3.67; P = 0.011), and multiple tumors (HR, 5.16; P = 0.005) independently predicted poorer RFS. Among patients with rim enhancement, narrow margins and microvascular invasion were strongly associated with early recurrence.Conclusion  ICG fluorescence patterns provide prognostic information in HCC. Rim enhancement identifies high-risk tumors and may guide intraoperative decisions to achieve wider resection margins and improve oncologic outcomes.
SN  - 2288-6575
SN  - 2288-6796
ER  -