Research Article
Indocyanine Green Fluorescence Imaging-guided Hepatectomy for Hepatocellular Carcinoma Following Neoadjuvant Therapy
Issue:
Volume 15, Issue 1, March 2026
Pages:
1-10
Received:
29 March 2026
Accepted:
16 April 2026
Published:
28 April 2026
DOI:
10.11648/j.sjcm.20261501.11
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Abstract: Background: Neoadjuvant therapy has improved the resectability of locally advanced hepatocellular carcinoma (HCC), but treatment-induced tumor necrosis and fibrosis often obscure tumor boundaries, making margin control challenging during non-anatomical hepatectomy (NAH). This study evaluated the efficacy of indocyanine green (ICG) fluorescence imaging for tumor delineation and resection margin control in this patient population. Methods: This retrospective observational study included 110 patients with HCC who received neoadjuvant therapy and subsequently underwent NAH between January 2018 and January 2024. After exclusions, 88 eligible patients were divided into ICG-guided (n=40) and conventional surgery (n=48) groups, with 38 matched pairs (38 vs. 38) after 1: 1 propensity score matching (PSM). Primary outcomes included adequate/positive resection margin rates and boundary identification accuracy; secondary outcomes were perioperative and oncological outcomes. Results: The ICG group demonstrated a significantly higher adequate margin rate (92.1% vs. 73.7%, p = 0.034) and improved tumor boundary identification accuracy (89.5% vs. 63.2%, p = 0.012). The positive margin rate was lower in the ICG group (2.6% vs. 18.4%, p = 0.058). Length of hospital stay was significantly shorter (7.1 ± 2.0 vs. 9.4 ± 2.7 days, p = 0.001), while operative time, blood loss, and postoperative complication rates were comparable. No significant differences in recurrence-free survival (RFS) or overall survival (OS) were observed. Conclusions: ICG fluorescence imaging enhances tumor boundary visualization and may improve resection margin quality in NAH following neoadjuvant therapy for HCC, representing a valuable intraoperative navigation tool.
Abstract: Background: Neoadjuvant therapy has improved the resectability of locally advanced hepatocellular carcinoma (HCC), but treatment-induced tumor necrosis and fibrosis often obscure tumor boundaries, making margin control challenging during non-anatomical hepatectomy (NAH). This study evaluated the efficacy of indocyanine green (ICG) fluorescence imag...
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,
Yue Liu
