Zeng Xiaojun, Li Xinci, Lin Wenjun, Wang Junfeng, Fang Chihua, Pan Mingxin, Tao Haisu, Yang Jian
Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China.
Guangdong Provincial Clinical and Engineering Center of Digital Medicine, Guangzhou, China.
Int J Surg. 2025 Feb 1;111(2):1749-1759. doi: 10.1097/JS9.0000000000002193.
Laparoscopic parenchyma-sparing hepatectomy (PSH) is an effective treatment for colorectal liver metastases (CRLMs), but ensuring the safety and radicality of the procedure, particularly for deep-seated tumors, remains challenging. Surgical navigation technologies such as augmented reality navigation (ARN) and indocyanine green fluorescence imaging (ICG-FI) are increasingly utilized to guide surgery, yet their efficacy for CRLMs is unclear. This study aims to evaluate the short-term and long-term outcomes of ARN combined with ICG-FI-guided (ARN-FI) laparoscopic PSH for CRLMs.
Between January 2020 and December 2022, 89 consecutive patients who underwent laparoscopic PSH for CRLMs were included in the study. Patients were divided into an ARN-FI group ( n = 38) and a non-ARN-FI group ( n = 51) based on the use of ARN-FI. Inverse probability treatment weighting (IPTW) was used to balance baseline characteristics and minimize potential selection bias. Short-term and long-term outcomes were compared between the two groups. Cox regression analysis was conducted to identify risk factors associated with recurrence-free survival (RFS) and hepatic RFS.
After IPTW, there were 87 patients in the ARN-FI group and 89 patients in the non-ARN-FI group. Shorter parenchymal transection time, postoperative hospital stays, and wider margins were observed in the ARN-FI group. There was no significant difference in RFS or hepatic RFS between the groups. Mutant KRAS status was an independent risk factor for both RFS and hepatic RFS, while tumor diameter ≥ 5 cm and deep-seated location were risk factors for hepatic RFS. In the subgroup analysis of deep-seated tumors, the ARN-FI group also showed less intraoperative blood loss, a lower rate of strategy change, shorter postoperative recovery times, a higher R0 resection rate, and improved RFS and hepatic RFS.
In laparoscopic PSH for CRLMs, ARN-FI may improve surgical efficiency and accuracy. Especially for deep-seated tumors, it has the potential to reduce blood loss and attain higher R0 resection rates.
腹腔镜保留实质肝切除术（PSH）是治疗结直肠癌肝转移（CRLMs）的有效方法，但确保手术的安全性和根治性，尤其是对于深部肿瘤，仍然具有挑战性。诸如增强现实导航（ARN）和吲哚菁绿荧光成像（ICG-FI）等手术导航技术越来越多地用于指导手术，但其对CRLMs的疗效尚不清楚。本研究旨在评估ARN联合ICG-FI引导（ARN-FI）的腹腔镜PSH治疗CRLMs的短期和长期疗效。
2020年1月至2022年12月期间，连续89例行腹腔镜PSH治疗CRLMs的患者纳入本研究。根据是否使用ARN-FI，将患者分为ARN-FI组（n = 38）和非ARN-FI组（n = 51）。采用逆概率处理加权（IPTW）来平衡基线特征并最小化潜在的选择偏倚。比较两组的短期和长期疗效。进行Cox回归分析以确定与无复发生存期（RFS）和肝脏RFS相关的危险因素。
IPTW后，ARN-FI组有87例患者，非ARN-FI组有89例患者。ARN-FI组的实质切开时间更短、术后住院时间更短且切缘更宽。两组之间的RFS或肝脏RFS无显著差异。KRAS突变状态是RFS和肝脏RFS的独立危险因素，而肿瘤直径≥5 cm和深部位置是肝脏RFS的危险因素。在深部肿瘤的亚组分析中，ARN-FI组还显示术中出血量更少、策略改变率更低、术后恢复时间更短、R0切除率更高，以及RFS和肝脏RFS得到改善。
在腹腔镜PSH治疗CRLMs中，ARN-FI可能提高手术效率和准确性。特别是对于深部肿瘤，它有可能减少出血并获得更高的R0切除率。
