背景:肝切除术是肝癌的治疗方法。减少复发率和提高肝脏恶性肿瘤的总生存率的关键因素是获得阴性边缘肝切除术。最近,吲哚菁绿(ICG)荧光成像已被证明可以帮助腹腔镜肝切除术,使实时肿瘤识别和精确的肝脏分割。这项研究的目的是进行系统评价和荟萃分析,以确定ICG引导的腹腔镜肝切除术是否会产生更高的完全肿瘤根除(R0)切除术的发生率。
方法:搜索包含诸如PubMed、Cochrane图书馆数据库,Scopus,ScienceDirect,和Ovid在2024年4月,严格遵守系统审查和荟萃分析(PRISMA)指南的首选报告项目。涉及接受ICG引导的腹腔镜肝切除术和报告的R0切除结果的恶性肝病变患者的研究符合纳入本综述的条件。
结果:在总共七项研究中,涉及598名患者,纳入荟萃分析。与非ICG组相比,ICG显示R0切除率显着升高[98.6%(359/364)与93.1%(339/364),比值比(OR)=3.76,95%置信区间(CI)1.45-9.51,P=0.005]。值得注意的是,没有观察到异质性(I2=0%,P=0.5)。然而,针对肝细胞癌的亚型分析[98.2%(165/168)与93.6%(161/172),OR=3.34,95%CI0.94-11.91,P=0.06)和边缘距离的评估(4.96±2.41vs.2.79±1.92毫米,加权平均差=1.26,95%CI-1.8-4.32,P=0.42)显示无明显差异。此外,两组患者术后总并发症发生率相当,ICG组为27.6%(66/239),非ICG组为25.4%(75/295)(OR=0.96,95%CI0.53-1.76,P=0.9)。手术时间没有发现差异,术中失血,术后输血,以及手术后的住院时间。
结论:实施ICG引导的腹腔镜肝切除术可以放心地进行,因为它不会影响术中或术后事件。此外,ICG引导的方法有利于在肝切除期间实现肿瘤的完全根除.
背景:PROSPERO注册号CRD42023446440。
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.
BACKGROUND: PROSPERO registration number CRD42023446440.