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Meta-Analysis
. 2025 Mar;39(3):1681-1695.
doi: 10.1007/s00464-024-11518-y. Epub 2025 Jan 13.

Efficacy and safety of indocyanine green fluorescence navigation versus conventional laparoscopic hepatectomy for hepatocellular carcinoma: a systematic review and meta-analysis

Manqin Hu  1   2 , Zhangbin Chen  1 , Dingwei Xu  1 , Yan Zhang  1 , Guangna Song  1 , Haoyang Huang  1 , Jie Huang  3
Affiliations
Meta-Analysis

Efficacy and safety of indocyanine green fluorescence navigation versus conventional laparoscopic hepatectomy for hepatocellular carcinoma: a systematic review and meta-analysis

Manqin Hu et al. Surg Endosc. 2025 Mar.

Abstract

Background: Indocyanine green (ICG) fluorescence imaging technology is increasingly widely used in laparoscopic hepatectomy. However, previous studies have produced conflicting results regarding whether it is truly superior to traditional laparoscopic hepatectomy. This study investigated the clinical effect of laparoscopic hepatectomy for hepatocellular carcinoma (HCC) using ICG imaging technology.

Methods: A systematic review and meta-analysis, based on the preferred reporting items for systematic reviews and meta-analysis statement, were conducted (PROSPERO: CRD42024532356). A computer search was conducted in databases including CNKI, Wanfang, PubMed, Embase, Cochrane Library, and Web of Science from January 1, 1990, to April 30, 2024.

Results: A total of 17 articles were included after screening, comprising 4 randomized controlled trials and 13 case-control studies, with 1620 patients in total. Among these, there were 743 cases in the fluorescence laparoscopy group and 877 cases in the non-fluorescence laparoscopy group. Hepatectomy guided by indocyanine green fluorescence navigation significantly reduced operation time (MD = - 23.25, 95% CI: - 36.35 to - 10.15, P = 0.0005), intraoperative blood loss (MD = - 51.04, 95% CI: - 69.52 to - 32.56, P < 0.00001), and intraoperative transfusion rate (OR = 0.43, 95% CI: 0.27 to 0.69, P = 0.0004), while increasing the R0 resection rate (OR = 2.93, 95% CI: 1.73 to 4.96, P < 0.0001) and decreasing the postoperative complication rate (OR = 0.59, 95% CI: 0.43 to 0.82, P = 0.002). However, there was no statistically significant difference in postoperative length of hospital stay (MD = - 0.67, 95% CI: - 1.51 to 0.18, P = 0.12).

Conclusion: In the treatment of HCC, hepatectomy guided by indocyanine green fluorescence navigation demonstrates superior efficacy and safety, its application and promotion are warranted.

Keywords: Fluorescence; Hepatectomy; Hepatocellular carcinoma; Indocyanine green; Laparoscopy; Meta-analysis.

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Conflict of interest statement

Declarations. Disclosures: Manqin Hu, Zhangbin Chen, Dingwei Xu, Yan Zhang, Guangna Song, Haoyang Huang, and Jie Huang have no conflicts of interest or financial ties to disclose. No (financial) support from this organization has been received for the submitted manuscript. Neither have there been any other activities nor relations that have influenced the submitted work. This work was supported by the Academic Leadership Training Program at the Second Affiliated Hospital of Kunming Medical University (Grant No. RCTDXS-202309).

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