Background: Indocyanine green fluorescence imaging (ICG-FI) is increasingly used in laparoscopic hepatectomy (LH). However, its efficacy in enhancing both short- and long-term outcomes in difficult LH for hepatocellular carcinoma (HCC) compared with traditional white light (WL) LH remains unclear.
Methods: This retrospective cohort study analyzed 573 patients who underwent LH between April 2018 and April 2023, stratified by the use of ICG-FI or WL. Propensity score matching (PSM, 1:1) was employed to minimize baseline discrepancies and reduce selection bias. Perioperative outcomes, overall survival (OS), and recurrence-free survival (RFS) were evaluated. Kaplan-Meier survival analysis was conducted to compare OS and RFS between groups, and Cox regression models were applied to identify independent prognostic factors.
Results: Among the 573 patients who underwent LH, 178 were classified as high-difficulty hepatectomies, including 47 patients in the ICG-FI group and 131 in the WL group. After PSM, 78 patients were matched, with 39 patients in each group. In both unmatched and matched cohorts, the ICG-FI group demonstrated significantly lower conversion rates (2.6% vs. 15.4%, P = 0.048), shorter durations of drainage tube placement (7.0 [5.0, 8.0] vs. 7.0 [6.0, 9.5], P = 0.048), fewer severe postoperative complications (2.6% vs. 15.4%, P = 0.048), and reduced postoperative hospital stays (7 [4.5, 9] vs. 8 [7, 10], P = 0.045). Kaplan-Meier analysis revealed significantly improved RFS in the ICG-FI group compared with the WL group (P = 0.021). Independent predictors of RFS included ICG-FI, liver cirrhosis, and the presence of satellite nodules. Independent predictors of OS included LH performed at the expert difficulty level (HR = 2.875, 95% CI: 1.331-6.207, P = 0.007) and R0 resection (HR = 0.142, 95% CI: 0.028-0.734, P = 0.020).
Conclusions: ICG-FI demonstrates significant benefits in short-term outcomes and enhances RFS in patients undergoing difficult LH for HCC. However, its impact on OS warrants further validation through large-scale, multicenter prospective studies.
