ArticleAnnals of surgical treatment and research2026
Prognostic significance of indocyanine green fluorescence patterns in resected hepatocellular carcinoma: a retrospective analysis of prospectively collected data.
Article in Annals of surgical treatment and research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Purpose: Indocyanine green (ICG) fluorescence imaging enables intraoperative visualization of liver tumors and reflects distinct tumor biology according to uptake patterns. However, its prognostic significance in hepatocellular carcinoma (HCC), particularly in relation to resection margins, remains unclear. This study evaluated the impact of ICG fluorescence patterns on recurrence-free survival (RFS) after curative resection for HCC. Methods: We retrospectively analyzed prospectively collected data from 66 patients who underwent HCC resection with intraoperative ICG fluorescence assessment between September 2021 and December 2023. Results: ICG patterns were classified as total uptake (n = 8), partial uptake (n = 41), or rim enhancement (n = 17). Rim enhancement was associated with significantly higher early recurrence rates (47.1% vs. 12.2% vs. 0%, P = 0.003) and shorter RFS (13.6 months vs. 17.1 months vs. 22.8 months, P = 0.003). On multivariate analysis, rim enhancement (hazard ratio [HR], 7.18; P < 0.001), resection margin ≤2 mm (HR, 3.67; P = 0.011), and multiple tumors (HR, 5.16; P = 0.005) independently predicted poorer RFS. Among patients with rim enhancement, narrow margins and microvascular invasion were strongly associated with early recurrence. Conclusion: ICG fluorescence patterns provide prognostic information in HCC. Rim enhancement identifies high-risk tumors and may guide intraoperative decisions to achieve wider resection margins and improve oncologic outcomes.
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