Indocyanine green fluorescence–guided laparoscopic anatomical hepatectomy for radical resection of hepatocellular carcinoma: a clinical study
- 1Department of Hepatopancreatobiliary Surgery, Ganzhou People’s Hospital, Ganzhou, Jiangxi Province, China
- 2Department of General Surgery, Wanan County People’s Hospital, Ji’an, Jiangxi Province, China
Abstract
INTRODUCTION:: Anatomical hepatectomy improves outcomes in hepatocellular carcinoma (HCC), but remains technically demanding laparoscopically. Indocyanine green (ICG) fluorescence may aid navigation, yet its clinical value remains unproven.
AIM:: We aimed to evaluate whether ICG-guided laparoscopic anatomical hepatectomy improved resection quality and short-term outcomes, as compared with conventional high-definition laparoscopy.
MATERIALS AND METHODS:: In this single-center, prospective, open-label, parallel-group randomized controlled trial (October 2023–December 2025), 100 patients with resectable primary HCC were randomized at a 1:1 ratio to the ICG-guided laparoscopic anatomical hepatectomy (n = 50) or conventional laparoscopy (n = 50) cohorts. The ICG protocol included preoperative intravenous ICG plus intraoperative ultrasound-guided positive / negative staining. Primary outcomes were anatomical resection and R0 rates. Secondary outcomes included blood loss, complications, 1-year disease-free survival (DFS), and overall survival (OS).
RESULTS:: Baseline characteristics of the study population were balanced. Tumor fluorescence and segmental staining were successful in 94% and 98% of the ICG patients, respectively. The ICG group achieved higher anatomical resection (94% vs 58%; P <0.001) and R0 rates (100% vs 86%; P = 0.01), wider margins (mean [SD], 10.27 [3.39] vs 6.97 [4.11] mm; P <0.001), less mean blood loss (217.2 [88.76] vs 298.44 [156.19] ml; P = 0.002), fewer complications (18% vs 50%; P <0.001), and shorter hospital stay (mean, 7.65 [1.68] vs 8.93 [2.84] d; P = 0.008) than the controls. ICG detected additional lesions in 20% of the patients. One-year DFS (88% vs 75.04%) and OS (93.82% vs 91.49%; P = 0.8) were similar in both groups. Adjusted recurrence hazard ratio was 2.146 (95% CI, 0.932–4.938; P = 0.07).
CONCLUSIONS:: ICG fluorescence-guided laparoscopic anatomical hepatectomy is safe and feasible, significantly improving radical resection quality with more anatomical dissections, higher R0 rates, wider margins, and fewer complications, as compared with the conventional approach. Longer follow-up is needed to confirm survival benefits.
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BibTeX
@article{he2026indocyanine,
title = {{Indocyanine green fluorescence–guided laparoscopic anatomical hepatectomy for radical resection of hepatocellular carcinoma: a clinical study}},
author = {Yong He and Yao Xiao and Yuancai Xie and Xiaohong Deng and Yonghui Liao and Wenhui Chen and Long Zhang},
journal = {Videosurgery and other Miniinvasive Techniques},
year = {2026},
month = oct,
doi = {10.20452/wiitm.2026.18047},
url = {https://doi.org/10.20452/wiitm.2026.18047},
note = {CC BY-NC-SA 4.0},
}
RIS
TY - JOUR
TI - Indocyanine green fluorescence–guided laparoscopic anatomical hepatectomy for radical resection of hepatocellular carcinoma: a clinical study
AU - Yong He
AU - Yao Xiao
AU - Yuancai Xie
AU - Xiaohong Deng
AU - Yonghui Liao
AU - Wenhui Chen
AU - Long Zhang
PY - 2026
DA - 2026/10/19
JO - Videosurgery and other Miniinvasive Techniques
DO - 10.20452/wiitm.2026.18047
UR - https://doi.org/10.20452/wiitm.2026.18047
AB - INTRODUCTION:: Anatomical hepatectomy improves outcomes in hepatocellular carcinoma (HCC), but remains technically demanding laparoscopically. Indocyanine green (ICG) fluorescence may aid navigation, yet its clinical value remains unproven. AIM:: We aimed to evaluate whether ICG-guided laparoscopic anatomical hepatectomy improved resection quality and short-term outcomes, as compared with conventional high-definition laparoscopy. MATERIALS AND METHODS:: In this single-center, prospective, open-label, parallel-group randomized controlled trial (October 2023–December 2025), 100 patients with resectable primary HCC were randomized at a 1:1 ratio to the ICG-guided laparoscopic anatomical hepatectomy (n = 50) or conventional laparoscopy (n = 50) cohorts. The ICG protocol included preoperative intravenous ICG plus intraoperative ultrasound-guided positive / negative staining. Primary outcomes were anatomical resection and R0 rates. Secondary outcomes included blood loss, complications, 1-year disease-free survival (DFS), and overall survival (OS). RESULTS:: Baseline characteristics of the study population were balanced. Tumor fluorescence and segmental staining were successful in 94% and 98% of the ICG patients, respectively. The ICG group achieved higher anatomical resection (94% vs 58%; P <0.001) and R0 rates (100% vs 86%; P = 0.01), wider margins (mean [SD], 10.27 [3.39] vs 6.97 [4.11] mm; P <0.001), less mean blood loss (217.2 [88.76] vs 298.44 [156.19] ml; P = 0.002), fewer complications (18% vs 50%; P <0.001), and shorter hospital stay (mean, 7.65 [1.68] vs 8.93 [2.84] d; P = 0.008) than the controls. ICG detected additional lesions in 20% of the patients. One-year DFS (88% vs 75.04%) and OS (93.82% vs 91.49%; P = 0.8) were similar in both groups. Adjusted recurrence hazard ratio was 2.146 (95% CI, 0.932–4.938; P = 0.07). CONCLUSIONS:: ICG fluorescence-guided laparoscopic anatomical hepatectomy is safe and feasible, significantly improving radical resection quality with more anatomical dissections, higher R0 rates, wider margins, and fewer complications, as compared with the conventional approach. Longer follow-up is needed to confirm survival benefits.
SN - 1895-4588
SN - 2299-0054
ER -