| Objective:The objective of this study was to evaluate the safety and efficacy of indocyanine green ICG fluorescence real-time guided imaging in laparoscopic hepatectomy.Methods: A retrospective analysis of patients with primary liver cancer in First Affiliated Hospital of USTC from January 2018 to October 2021,including 48 cases of fluorescence-guided laparoscopic hepatectomy(FGLH)and 60 cases of traditional laparoscopic hepatectomy(TLH).The R0 resection rate,operation time,intraoperative blood loss,complications,hospital stay and other intraoperative and postoperative indicators of the two groups were analyzed to determine the clinical feasibility and safety of ICG fluorescence real-time imaging guided technology in laparoscopic hepatectomy.Search for retrospective cohort studies and randomized controlled trials comparing FGLH with TLH in related databases,screen literature according to preset inclusion and exclusion criteria,evaluate literature quality,and extract data.Revman 5.3software was used to conduct Meta analysis on the extracted data.Results: 1.1 Preoperative data including age,sex,Child-Pugh grade,AFP,liver function,platelet,prothrombin time and hepatitis B complications were not statistically significant between the two groups(P > 0.05).A total of 108 patients were able to tolerate surgery considering the general status of patients and tumor size,with no statistical significance(P > 0.05).The operative time and intraoperative blood loss of FGLH were less than those of TLH,and the comparison between the two was statistically significant(P < 0.05).The indexes of alanine aminotransferase,aspartate aminotransferase and leukocyte in 48 patients with FGLH were significantly better than those in 60 patients with TLH on the first day after surgery,with statistical significance(P < 0.05).The incidence of postoperative complications(including postoperative bile leakage,bleeding,effusion,etc.)in FGLH group was 10/48,comparing to 21/60 in the control group.The R0 resection rate in guided group was 100% which higher than95.0%(57/60)in the control group,and the postoperative hospital stay was shorter.Fluorescent navigation does not increase the cost,which may be related to the reduction of complications(Table 5)5.Meta analysis results(1)R0 resection: A total of 9 studies compared the R0 resection rate of the fluorescence laparoscopy group and the traditional laparoscopy group,a total of 707 cases.There was no heterogeneity among the studies(I2=0%,P >0.05),and the fixed effects model was used for analysis(Figure2and Table 6).The results of Meta analysis showed that: the R0 resection rate between the fluorescence laparoscopy group and the traditional laparoscopy group was significantly different(OR=3.35,95%CI:1.93～5.82,P <0.0001),as shown in Figure3.(2)Operation time: A total of 15 studies compared the operation time of the fluorescence laparoscopy group and the traditional laparoscopy group,with a total of1208 cases.There is heterogeneity among the studies(I2=80%,P < 0.05),and the random effects model is used for analysis.The results of Meta analysis showed that the difference in operation time between the fluorescence laparoscopy group and the traditional laparoscopy group was statistically significant(MD=-15.26,95%CI:-19.70～-10.82,P < 0.05),as shown in Figure 4.(3)Intraoperative blood loss: A total of 10 studies compared the intraoperative blood loss of the fluorescence laparoscopy group and the traditional laparoscopy group,with a total of 810 cases.The homogeneity of the studies was good(I2=49%,P =0.04),and the fixed effects model was used for analysis.The results of Meta analysis showed that the intraoperative blood loss between the fluorescence laparoscopy group and the traditional laparoscopy group was significantly different(MD=-48.65,95%CI:-53.07～-44.22,P <0.00001),as shown in Figure 5.(4)Postoperative hospital stay: A total of 10 studies compared the postoperative hospital stay of the fluorescence laparoscopy group and the traditional laparoscopy group,with a total of 769 cases.The homogeneity of the studies was good(I2=18%,P >0.05),and the fixed effects model was used for analysis.The results of Meta analysis showed that: the difference in hospital stay between the fluorescence laparoscopy group and the traditional laparoscopy group was statistically significant(MD=-1.15,95%CI:-1.51～-0.79,P <0.000001),as shown in Figure 6.(5)Postoperative complications: A total of 14 studies compared the postoperative hospital stays of the fluorescence laparoscopy group and the traditional laparoscopy group,with a total of 1198 cases.There is no heterogeneity among the studies(I2=0%,P >0.05),and the fixed effects model is used for analysis.The results of Meta analysis showed that: the postoperative complications of the fluorescence laparoscopy group and the traditional laparoscopy group were compared with statistical significance(OR=0.63,95%CI:0.45～0.88,P <0.05),as shown in Figure 7.The funnel chart results show that the scattered points are in the funnel chart and are roughly symmetrically distributed,suggesting that the included studies have no obvious publication bias and have little influence on the results of the Meta analysis(Figure 8).Conclusion: Both our own clinical data and Meta analysis,the results showed that compared with TLH,FGLH increased the R0 resection rate;shortened the operation time and postoperative hospital stay;reduced blood losing and the occurrence of postoperative complications.Compared with TLH,FGLH has a better application effect in laparoscopic hepatectomy,and it is worthy of promotion as its safe and feasible. |
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