Objective:To evaluate the feasibility and safety of ICG fluorescence staining in laparoscopic anatomical hepatectomy for primary liver cancer (PLC).Methods:Clinical data of 52 PLC patients who underwent laparoscopic anatomical hepatectomy in the Fifth Medical Center of Chinese PLA General Hospital from January to December 2021 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 40 patients were male and 12 female, aged (56±9) years on average. According to China Liver Cancer Staging (CNLC) System, 34 cases were classified as stage Ⅰa, 13 cases of stage Ⅰb and 5 cases of stage Ⅱa, respectively. The median tumor diameter was 3.1(1.1-13.2) cm. Three-dimensional visualization reconstruction and evaluation were performed before operation. Intraoperative ultrasound-guided ICG fluorescence staining was carried out. Intraoperative ICG staining, intraoperative and postoperative conditions, and postoperative follow-up were observed.Results:All patients successfully completed the operation. Of 52 patients, ICG staining were performed successfully in 45 cases and failed in 7 cases. 32 patients were subject to reverse staining, and2 cases failed with a success rate of 94%. 20 cases received positive staining and 5 cases failed, with a success rate of 75%. Surgical methods included laparoscopic right hepatectomy in 5 cases, left liver resection in4 cases, right anterior lobectomy in 7 cases, right posterior lobectomy in 2 cases, middle lobe resection in2 cases, segment Ⅴ resection in 11 cases, segment Ⅵ resection in 1 case, segment Ⅶ resection in 11 cases and segment Ⅷ resection in 9 cases, respectively. The operation time was 279 (88-447) min, and intraoperative blood loss was 200 (50-500) ml. The length of postoperative hospital stay was (9.1±3.5) d. Postoperative complications occurred in 3 patients, including 1 case of bile leakage, which was treated after drainage, 1 case of pleural effusion, which was cured by thoracic puncture and drainage, and 1 case of pulmonary infection, which was healed after anti-infection treatment. No bleeding, other postoperative complications or death was observed. During postoperative follow-up, 2 cases developed intrahepatic recurrence.Conclusions:It is safe and feasible to perform ICG fluorescence staining in laparoscopic anatomical hepatectomy. The success rate of reverse staining is high. Positive staining is especially suitable for anatomical hepatectomy of difficult segments, such as posterior and upper hepatic segments.
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