Avella Pasquale, Spiezia Salvatore, Rotondo Marco, Cappuccio Micaela, Scacchi Andrea, Inglese Giustiniano, Guerra Germano, Brunese Maria Chiara, Bianco Paolo, Tedesco Giuseppe Amedeo, Ceccarelli Graziano, Rocca Aldo
Department of Clinical Medicine and Surgery, University of Naples "Federico II", 80138 Naples, Italy.
Hepatobiliary and Pancreatic Surgery Unit, Department of General Surgery, Pineta Grande Hospital, 81030 Castel Volturno, Italy.
Cancers (Basel). 2025 Mar 3;17(5):872. doi: 10.3390/cancers17050872.
Indocyanine green (ICG) fluorescence has seen extensive application across medical and surgical fields, praised for its real-time navigation capabilities and low toxicity. Initially employed to assess liver function, ICG fluorescence is now integral to liver surgery, aiding in tumor detection, liver segmentation, and the visualization of bile leaks. This study reviews current protocols and ICG fluorescence applications in liver surgery, with a focus on optimizing timing and dosage based on clinical indications.
Following PRISMA guidelines, we systematically reviewed the literature up to 27 January 2024, using PubMed and Medline to identify studies on ICG fluorescence used in liver surgery. A systematic review was performed to evaluate dosage and timing protocols for ICG administration.
Of 1093 initial articles, 140 studies, covering a total of 3739 patients, were included. The studies primarily addressed tumor detection (40%), liver segmentation (34.6%), and both (21.4%). The most common ICG fluorescence dose for tumor detection was 0.5 mg/kg, with administration occurring from days to weeks pre-surgery. Various near-infrared (NIR) camera systems were utilized, with the PINPOINT system most frequently cited. Tumor detection rates averaged 87.4%, with a 10.5% false-positive rate. Additional applications include the detection of bile leaks, lymph nodes, and vascular and biliary structures.
ICG fluorescence imaging has emerged as a valuable tool in liver surgery, enhancing real-time navigation and improving clinical outcomes. Standardizing protocols could further enhance ICG fluorescence efficacy and reliability, benefitting patient care in hepatic surgeries.
吲哚菁绿（ICG）荧光已在医学和外科领域得到广泛应用，因其具有实时导航能力和低毒性而备受赞誉。ICG荧光最初用于评估肝功能，现在已成为肝脏手术不可或缺的一部分，有助于肿瘤检测、肝段划分以及胆汁漏的可视化。本研究回顾了肝脏手术中当前的操作方案和ICG荧光的应用，重点是根据临床指征优化给药时间和剂量。
遵循PRISMA指南，我们系统地回顾了截至2024年1月27日的文献，使用PubMed和Medline识别肝脏手术中使用ICG荧光的研究。进行了一项系统评价，以评估ICG给药的剂量和时间方案。
在1093篇初始文章中，纳入了140项研究，共涉及3739例患者。这些研究主要涉及肿瘤检测（40%）、肝段划分（34.6%）以及两者（21.4%）。肿瘤检测最常用的ICG荧光剂量为0.5mg/kg，给药时间为术前数天至数周。使用了各种近红外（NIR）摄像系统，其中PINPOINT系统被引用得最为频繁。肿瘤检测率平均为87.4%，假阳性率为10.5%。其他应用包括胆汁漏、淋巴结以及血管和胆管结构的检测。
ICG荧光成像已成为肝脏手术中的一种有价值的工具，增强了实时导航并改善了临床结果。规范操作方案可进一步提高ICG荧光的疗效和可靠性，使肝脏手术中的患者护理受益。
