Repeated laparoscopic liver resection using ICG fluorescent imaging for recurrent liver cancer

Abstract

Objective: Liver cancer is very common in China, with cumulative five-year tumor recurrence rate after a microscopically margin-negative resection of hepatocellular carcinoma up to 70%. Postoperative recurrent hepatocellular carcinoma presents a challenge for surgeons because of the complexity of postoperative adhesion and the difficulty in of recognizing recurrent lesions. This study aims to introduce a method using an indocyanine green (ICG) fluorescent imaging technique to do repeated laparoscopic liver resection. Method: Patients received repeated laparoscopic liver resection using ICG fluorescent imaging between January 2017 and December 2019 in the Department of General Surgery of Sir Run Run Shaw Hospital were analyzed retrospectively. Basic information, intraoperative information, complications, and follow-up time were collected and analyzed. Results: Totally, 35 patients with a median age of 59 years (ranged 38–82 years) were included. All of the patients received minimally invasive surgery. One case was performed robotically, and only two cases were converted to open surgery due to severe adhesion. The median operating time was 174 minutes, and the median blood loss during surgery was 100 mL. The median hospital stay after surgery was 5 days, with a range of 3–55 days. In total, 32 (91.4%) patients showed staining by ICG fluorescent imaging, and lesions were visible on fluorescent camera. The median follow-up time was 19.7 months, with a range of 1–40.2 months. The median relapse-free survival time was 18.5 months. Conclusion: Repeated laparoscopic liver resection using ICG fluorescent imaging is a safe and promising approach in the treatment of recurrent liver tumors in selected patients.

Keywords

• Recurrence
• Liver cancer
• Laparoscopic hepatectomy
• Fluorescent imaging