Does application of indocyanine green fluorescence imaging enhance clinical outcomes in liver resection? A meta-analysis

Indocyanine green fluorescence imaging technology has been widely used in liver resection. However, there has been a lack of strong evidence on whether application of indocyanine green fluorescence imaging enhances clinical outcomes in liver resection. This meta-analysis was performed to compare the latest clinical results of indocyanine green fluorescence imaging-guided hepatectomy (FIGH) and conventional hepatectomy (CH) in liver diseases.Relevant clinical studies were retrieved from PubMed, Embase, Cochrane Library, Medline and the Web of Science databases until June 21, 2021. Stata14.0 software was adopted in meta-analysis, in which the pooled effect size was calculated by the random-effects model or the fixed-effects model. Meta-regression and subgroup analysis were used to explore sources of heterogeneity. The publication bias was ascertained by egger's test and begg's test. The trim and fill method was used to adjust the occurrence of publication bias.Overall twelve studies comprising 931 patients were included. Compared to the CH group, the FIGH group has lower complications (weighted mean difference [WMD] = 0.5238; 95% CI = 0.351-0.780; P = 0.001), shorter hospital stays (WMD = -1.857; 95% CI = -2.806--0.908; P = 0.000). Six of the studies indicated that no perioperative mortality occurred in either group. In overall analysis, there was no statistical difference in the estimated blood loss between the two groups (WMD = -42.509; 95% CI = -87.842 -2.825; P = 0.066), while in subgroup analysis of only literature from Japan or published between 2018 and 2019 years showed the consistent results above (WMD = 5.613; 95% CI = -45.101-56.328; P = 0.828. WMD = 5.582; 95% CI = -34.597-45.762; P = 0.785). No significant differences were found in operative time, blood transfusion rate, R0 resection, 1-year recurrence rate, 2-year-recurrence rate and the 1-year overall survival rate (P > 0.05).This meta-analysis showed that during the liver resection operation, application of indocyanine green fluorescence imaging is a feasible and safe method in the treatment of liver diseases, which enhances some clinical outcomes, such as lower complications and shorter hospital stays.