Indocyanine green fluorescence staining-guided laparoscopic posterosuperior segmentectomy: A multicenter retrospective cohort study.

[BACKGROUND/PURPOSE] Existing studies lack comparisons of traditional anatomic resection and indocyanine green (ICG) fluorescence staining for difficult liver resections, such as laparoscopic posterosuperior segmentectomy (LPSS). The aim of this study was to compare short-term postoperative prognosis and tumor outcomes between two LPSS methods, including detailed descriptions of different staining methods.

[METHODS] We retrospectively analyzed clinical data from 290 patients who underwent LPSS for hepatocellular carcinoma. Based on the staining methods used, patients were categorized into ICG staining (ICG) and no-ICG staining (NICG) groups. We summarized the two surgical techniques, compared the short-term postoperative results and tumor outcomes, and offered recommendations for selecting the appropriate method.

[RESULTS] There were 191 (65.86%) and 99 (34.14%) patients in the ICG and NICG groups, respectively. After conducting 1:1 propensity score matching (PSM), 96 pairs were matched. There were no significant differences in baseline data before and after inverse probability of treatment weighting (IPTW) and PSM. The amount of surgical bleeding, the incidence of postoperative complications, and the length of postoperative hospital stays were significantly lower in the ICG group than in the NICG group under similar operation times after IPTW and PSM. There were no significant differences in median overall survival and progression-free survival between the groups before and after IPTW and PSM.

[CONCLUSIONS] ICG staining can visually display an intersegmental three-dimensional plane, enabling accurate navigation that is helpful for safe LPSS. The appropriate staining method should be selected according to the technical ability of the surgeon and the anatomical condition of the liver.