The Comparison of Laparoscopy and Fluorescent Laparoscopy in Anatomical Liver Resection in Hepatocellular Carcinoma Patients: A Systematic Review and Meta-Analysis
Bibliographic record
Abstract
Anatomic liver resection (AR) is a surgical technique that aims to completely remove the tumor-bearing portal territory (PT) and improve the oncological efficacy of hepatocellular carcinoma (HCC). However, the classical AR technology system has some limitations in achieving this goal. Indocyanine green (ICG) fluorescence laparoscopy is an emerging technology that can accurately delineate the PT and guide the AR. However, the evidence of its efficacy compared to conventional laparoscopy is scarce. This systematic review and meta-analysis aims to compare the effectiveness of laparoscopy and ICG fluorescence laparoscopy in AR for HCC patients. This systematic review was registered on the International Prospective Register of Systematic Reviews platform (ID: CRD42023456121). Empirical research comparing perioperative effectiveness between ICG fluorescence laparoscopy and conventional laparoscopy published from inception to 26th November 2023 in several academic literature databases was included. Cochrane risk-of-bias tool (RoB) and the Newcastle-Ottawa scale (NOS) were used for study quality evaluations. Information on clinical characteristics, operative, postoperative, prognosis, and pathological outcomes was retrieved for review. Publication bias and heterogeneity were tested for each outcome. The effect size odds ratio (OR) and standard mean difference (SMD) were calculated and synthesized. The quality of evidence was evaluated using the GRADE system. A total of 13 studies were included. Clinical characteristics were comparable between the ICG fluorescence laparoscopy group and the conventional laparoscopy group. Compared with conventional laparoscopy, ICG fluorescence laparoscopy is associated with superior short- and long-term clinical outcomes in HCC patients undergoing hepatectomy. Especially in the aspects of reduced intraoperative blood loss (SMD=-0.743, P=0.002), decreased risks of blood transfusion (OR=0.459, P=0.004), and shorter postoperative hospitalization times (SMD=-0.391, P<0.001). ICG fluorescence laparoscopy also showed implications for fewer postoperative complications (OR=0.657, P=0.071), higher R0 resection rates (OR=3.013, P=0.068), greater margin distances (SMD=0.559, P=0.072), and longer recurrence-free survival, although these findings were not statistically significant and require further investigation. ICG fluorescence laparoscopy is a safe and effective technique for AR in HCC patients. It can achieve accurate and complete resection of tumor-bearing PT and Glisson systems, as well as preserve the function and venous outflow of the future remaining liver. This study provides valuable evidence to support the clinical application of ICG fluorescence laparoscopy in AR for HCC.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.010 | 0.026 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.018 | 0.028 |
| Bibliometrics | 0.005 | 0.007 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".