Indocyanine green fluorescence versus modified inflation-deflation method in thoracoscopic anatomic segmentectomy: A systematic review and meta-analysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 ZHANG Chenglong , WANG Ruiyao , XIAO Kuo , CHEN Jun

Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, 300052, P. R. China;

Corresponding author：

ZHANG Chenglong, Email: chenglongzhang2023@163.com

Keywords：

Thoracoscopic segmentectomy; indocyanine green fluorescence; modified inflation-deflation; meta-analysis; systematic review

DOI：

10.7507/1007-4848.202307001

Video：

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Objective To evaluate the effectiveness and safety of indocyanine green fluorescence method versus modified inflation-deflation method for thoracoscopic anatomic segmentectomy. Methods CNKI, Wanfang Database, China Biomedical Literature Database, Web of Science, Cochrane Library, EMbase, PubMed, Clinicaltrials.gov, were searched from 1 January 2000 to 1 May 2023, and controlled studies between indocyanine green fluorescence and modified inflation deflation method in thoracoscopic segmentectomy were collected. Meta-analysis was performed using Stata14MP and RevMan5.4. Results A total of 10 articles, including 1 156 patients, were identified. In thoracoscopic anatomic segmentectomy, indocyanine green fluorescence method had an advantage over modified inflation deflation method. The total incidence of postoperative complications decreased (OR=0.51, 95%CI 0.36 to 0.71, P<0.0001). The incidence of air leaks decreased (OR=0.50, 95%CI 0.31 to 0.80, P=0.004), the operation time shortened (MD=−25.81, 95%CI −29.78 to −21.84, P<0.00001), the length of postoperative hospital stays shortened (MD=−0.98, 95%CI −1.57 to −0.39, P=0.001), the rate of clear displaying for intersegmental boundary line increased (OR=5.79, 95%CI 2.76 to 12.15, P<0.00001). The difference was statistically significant. Conclusion Compared with modified inflation deflation method, indocyanine green fluorescence method can quickly and clearly display the intersegmental boundary line, reduce the difficulty of surgery, shorten the operation time, reduce the length of postoperative hospital stay, and provide reliably technical support for thoracoscopic anatomic segmentectomy. It is an effective and safe method, which is worthy of extensive application.

Citation： ZHANG Chenglong, WANG Ruiyao, XIAO Kuo, CHEN Jun. Indocyanine green fluorescence versus modified inflation-deflation method in thoracoscopic anatomic segmentectomy: A systematic review and meta-analysis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2024, 31(10): 1486-1495. doi: 10.7507/1007-4848.202307001 Copy

1.	Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
2.	Ettinger DS, Wood DE, Aisner DL, et al. NCCN guidelines insights: Non-small cell lung cancer, Version 2,2021. J Natl Compr Canc Netw, 2021, 19(3): 254-266.
3.	中华医学会肿瘤学分会, 中华医学会杂志社. 中华医学会肺癌临床诊疗指南(2022版). 中华医学杂志, 2022, 102(23): 1706-1740.Oncology Branch of the Chinese Medical Association, Chinese Medical Association Publishing House. Clinical diagnosis and treatment guidelines for lung cancer of the Chinese Medical Association (2022 edition). Natl Med J Chin, 2022, 102(23): 1706-1740.
4.	Aberle DR, Adams AM, Berg CD, et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med, 2011, 365(5): 395-409.
5.	Shao C, Zheng C, Yan W, et al. Evaluation of efficacy and safety of minimally invasive segmentectomy in the treatment of lung cancer. Oncol Lett, 2018, 15(6): 9516-9522.
6.	Saji H, Okada M, Tsuboi M, et al. Segmentectomy versus lobectomy in small-sized peripheral non-small-cell lung cancer (JCOG0802/WJOG4607L): A multicentre, open-label, phase 3, randomised, controlled, non-inferiority trial. Lancet, 2022, 399(10335): 1607-1617.
7.	金亮. 胸腔镜下肺段切除术在肺癌治疗中的现状. 中国微创外科杂志, 2018, 18(8): 749-752.Jin L. The current status of thoracoscopic segmentectomy in the treatment of lung cancer. Chin J Minim Invasive Surg, 2018, 18(8): 749-752.
8.	陈亮, 王俊, 吴卫兵, 等. 胸腔镜精准肺段切除术技术流程和质量控制. 中国胸心血管外科临床杂志, 2019, 26(1): 21-28.Chen L, Wang J, Wu WB, et al. Technical process and qualitycontrol of precise thoracoscopic lung segmentectomy. Chin J Clin Thorac Cardiovasc Surg, 2019, 26(1): 21-28.
9.	Fan W, Yang H, Ma J, et al. Indocyanine green fluorescence-navigated thoracoscopy versus traditional inflation-deflation approach in precise uniportal segmentectomy: A short-term outcome comparative study. J Thorac Dis, 2022, 14(3): 741-748.
10.	Liu Z, Yang R, Cao H. Near-infrared intraoperative imaging with indocyanine green is beneficial in video-assisted thoracoscopic segmentectomy for patients with chronic lung diseases: A retrospective single-center propensity-score matched analysis. J Cardiothorac Surg, 2020, 15: 303.
11.	郑发德, 郭晓彤. ICG荧光染色法与改良膨胀萎陷法在胸腔镜肺段切除中的对比研究. 影像科学与光化学, 2022, 40(5): 1211-1214.Zheng FD, Guo XT. Comparative study of ICG fluorescence stating and modified swelling collapse method in thoracoscopic segmental lung resection. Imag Sci Photochem, 2022, 40(5): 1211-1214.
12.	张彤, 马永富, 石渊博, 等. 荧光染色法与改良膨胀萎陷法判定段间平面在解剖性肺段切除术中的病例对照研究. 中华腔镜外科杂志(电子版), 2019, 12(6): 356-360.Zhang T, Ma YF, Shi YB, et al. Fluorescence method versus modified inflation-deflation method distinguish intersegmental plane in thoracoscopic anatomical segmentectomy. Chin J Laparosc Surg ( Electronic Edition), 2019, 12(6): 356-360.
13.	张春盛, 张仁泉, 郑浩. 吲哚菁绿在单孔胸腔镜肺段切除术中的应用价值. 安徽医学, 2022, 43(3): 330-333.Zhang CS, Zhang RQ, Zheng H. The application value of indocyanine green in single port thoracoscopic pulmonary segmentectomy. Anhui Med J, 2022, 43(3): 330-333.
14.	汪佳玮, 杨刚, 付金松, 等. 术前三维重建联合荧光染色法在单孔胸腔镜肺段切除术中的应用. 局解手术学杂志, 2022, 31(8): 717-720.Wang JW, Yang G, Fu JS, et al. Application of preoperative three-dimensional reconstruction combined with fluorescence staining in single-port thoracoscopic segmentectomy. J Reg Anat Oper Surg, 2022, 31(8): 717-720.
15.	孙云刚, 张强, 王朝, 等. 荧光法在单孔胸腔镜解剖性肺段切除术中识别段间交界线的可行性研究. 中国肺癌杂志, 2021, 24(11): 756-763.Sun YG, Zhang Q, Wang C, et al. Feasibility investigation of fluorescence method in uniport thoracoscopic anatomical segmentectomy for identifying the intersegmental boundary line. Chin J Lung Cancer, 2021, 24(11): 756-763.
16.	胡敏. 吲哚菁绿荧光法在胸腔镜肺段切除术中的应用. 皖南医学院, 2022.Hu M. Application of indocyanine green fluorescence in thoracoscopic segmental pulmonary surgery. Wannan Medical College. 2022.
17.	丁吉, 束余声, 陈勇, 等. 荧光染色法与膨胀-萎陷法在非小细胞肺癌肺段切除术中的对比研究. 中外医学研究, 2022, 20(17): 67-70.Ding J, Shu YS, Chen Y, et al. Comparative study of fluorescence staining and dilatation-collapse in segmentectomy of non small cell lung cancer. Chin Foreign Med Res, 2022, 20(17): 67-70.
18.	曹珲, 侍晔, 董长青, 等. 荧光反染法与膨胀萎陷法在单孔胸腔镜肺段切除术中的应用效果观察. 中国医刊, 2022, 57(1): 96-98.Cao H, Si Y, Dong CQ, et al. Observation of the application effect of fluorescence counterstaining and expansion collapse method in single port thoracoscopic pulmonary segmentectomy. Chin J Med, 2022, 57(1): 96-98.
19.	Kamel MK, Rahouma M, Lee B, et al. Segmentectomy is equivalent to lobectomy in hypermetabolic clinical stage ⅠA lung adenocarcinomas. Ann Thorac Surg, 2019, 107(1): 217-223.
20.	Tsubokawa N, Tsutan Y, Miyata Y, et al. Segmentectomy versus lobectomy for radiologically pure solid clinical T1a-bN0M0 lung cancer. World J Surg, 2018, 42(8): 2493-2501.
21.	Yao F, Wang J, Yao J, et al. Three-dimensional image reconstruction with free open-source OsiriX software in video-assisted thoracoscopic lobectomy and segmentectomy. Int J Surg, 2017, 39: 16-22.
22.	王黎彬, 戚维波. 三维重建及虚拟手术规划在胸腔镜解剖性肺段切除术中的应用进展. 浙江医学, 2019, 41(5): 485-486, 491.Wang LB, Qi WB. Progress of 3D reconstruction and virtual surgical planning in the endoscopic anatomical segmentectomy. Zhejiang Med J, 2019, 41(5): 485-486, 491.
23.	尤培林, 陈文树, 赵力澜, 等. 三维重建在单操作孔胸腔镜肺段切除术治疗早期非小细胞肺癌中的应用: 一项倾向性评分匹配研究. 肿瘤防治研究, 2021, 48(4): 387-392.Long PL, Chen WS, Zhao LL, et al. Application of three-dimensional reconstruction in single utility-port thoracoscopic segmentectomy for early stage non-small cell lung cancer: A propensity scorematched analysis. Cancer Res Prev Treat, 2021, 48(4): 387-392.
24.	Andolfi M, Potenza R, Seguin-Givelet A, et al. Identification of the intersegmental plane during thoracoscopic segmentectomy: State of the art. Inter Cardiovasc Thorac Surg, 2020, 30(3): 329-336.
25.	Onodera K, Suzuki J, Miyoshi T, et al. Comparison of various lung intersegmental plane identification methods. Gen Thorac Cardiovasc Surg, 2023, 71(2): 90-97.
26.	Zhang X, Li C, Jin R, et al. Intraoperative identification of the intersegmental plane: From the beginning to the future. Front Surg, 2022, 9: 948878.
27.	Yotsukura M, Okubo Y, Yoshida Y, et al. Indocyanine green imaging for pulmonary segmentectomy. JTCVS Techniques, 2021, 6: 151-158.
28.	Wang J, Xu X, Wen W, et al. Modified method for distinguishing the intersegmental border for lung segmentectomy. Thorac Cancer, 2018, 9(2): 330-333.
29.	Motono N, Iwai S, Funasaki A, et al. Low-dose indocyanine green fluorescence-navigated segmentectomy: Prospective analysis of 20 cases and review of previous reports. J Thorac Dis, 2019, 11(3): 702-707.
30.	王保明, 吴峰, 马冬春, 等. 基于倾向性评分匹配法的荧光法与改良膨胀-萎陷法解剖性肺段切除术的近期效果比较. 中华胸心血管外科杂志, 2023, 39(3): 134-141.Wang BM, Wu F, Ma DC, et al. Comparison of short-term outcomes between fluorescence method versus modified inflation-deflation method on thoracoscopic anatomical segmentectomy: A study based on propensity score matching. Chin J Thorac Cardiovasc Surg, 2023, 39(3): 134-141.
31.	Watanabe A, Ohori S, Nakashima S, et al. Feasibility of video-assisted thoracoscopic surgery segmentectomy for selected peripheral lung carcinomas. Eur J Cardiothorac Surg, 2009, 35(5): 775-780.
32.	Iizuka S, Kuroda H, Yoshimura K, et al. Predictors of indocyanine green visualization during fluorescence imaging for segmental plane formation in thoracoscopic anatomical segmentectomy. J Thorac Dis, 2016. , 8(5): 985-991.
33.	Tang J. Effect and long-term outcomes of indocyanine green gluorescence imaging method versus modified inflation-Deflation method in identification of intersegmental plane(IMPLANE-0529). URL: https://clinicaltrials.gov/study/NCT05453721?term=NCT05453721&rank=1. 2022.

1. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
2. Ettinger DS, Wood DE, Aisner DL, et al. NCCN guidelines insights: Non-small cell lung cancer, Version 2,2021. J Natl Compr Canc Netw, 2021, 19(3): 254-266.
3. 中华医学会肿瘤学分会, 中华医学会杂志社. 中华医学会肺癌临床诊疗指南(2022版). 中华医学杂志, 2022, 102(23): 1706-1740.Oncology Branch of the Chinese Medical Association, Chinese Medical Association Publishing House. Clinical diagnosis and treatment guidelines for lung cancer of the Chinese Medical Association (2022 edition). Natl Med J Chin, 2022, 102(23): 1706-1740.
4. Aberle DR, Adams AM, Berg CD, et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med, 2011, 365(5): 395-409.
5. Shao C, Zheng C, Yan W, et al. Evaluation of efficacy and safety of minimally invasive segmentectomy in the treatment of lung cancer. Oncol Lett, 2018, 15(6): 9516-9522.
6. Saji H, Okada M, Tsuboi M, et al. Segmentectomy versus lobectomy in small-sized peripheral non-small-cell lung cancer (JCOG0802/WJOG4607L): A multicentre, open-label, phase 3, randomised, controlled, non-inferiority trial. Lancet, 2022, 399(10335): 1607-1617.
7. 金亮. 胸腔镜下肺段切除术在肺癌治疗中的现状. 中国微创外科杂志, 2018, 18(8): 749-752.Jin L. The current status of thoracoscopic segmentectomy in the treatment of lung cancer. Chin J Minim Invasive Surg, 2018, 18(8): 749-752.
8. 陈亮, 王俊, 吴卫兵, 等. 胸腔镜精准肺段切除术技术流程和质量控制. 中国胸心血管外科临床杂志, 2019, 26(1): 21-28.Chen L, Wang J, Wu WB, et al. Technical process and qualitycontrol of precise thoracoscopic lung segmentectomy. Chin J Clin Thorac Cardiovasc Surg, 2019, 26(1): 21-28.
9. Fan W, Yang H, Ma J, et al. Indocyanine green fluorescence-navigated thoracoscopy versus traditional inflation-deflation approach in precise uniportal segmentectomy: A short-term outcome comparative study. J Thorac Dis, 2022, 14(3): 741-748.
10. Liu Z, Yang R, Cao H. Near-infrared intraoperative imaging with indocyanine green is beneficial in video-assisted thoracoscopic segmentectomy for patients with chronic lung diseases: A retrospective single-center propensity-score matched analysis. J Cardiothorac Surg, 2020, 15: 303.
11. 郑发德, 郭晓彤. ICG荧光染色法与改良膨胀萎陷法在胸腔镜肺段切除中的对比研究. 影像科学与光化学, 2022, 40(5): 1211-1214.Zheng FD, Guo XT. Comparative study of ICG fluorescence stating and modified swelling collapse method in thoracoscopic segmental lung resection. Imag Sci Photochem, 2022, 40(5): 1211-1214.
12. 张彤, 马永富, 石渊博, 等. 荧光染色法与改良膨胀萎陷法判定段间平面在解剖性肺段切除术中的病例对照研究. 中华腔镜外科杂志(电子版), 2019, 12(6): 356-360.Zhang T, Ma YF, Shi YB, et al. Fluorescence method versus modified inflation-deflation method distinguish intersegmental plane in thoracoscopic anatomical segmentectomy. Chin J Laparosc Surg ( Electronic Edition), 2019, 12(6): 356-360.
13. 张春盛, 张仁泉, 郑浩. 吲哚菁绿在单孔胸腔镜肺段切除术中的应用价值. 安徽医学, 2022, 43(3): 330-333.Zhang CS, Zhang RQ, Zheng H. The application value of indocyanine green in single port thoracoscopic pulmonary segmentectomy. Anhui Med J, 2022, 43(3): 330-333.
14. 汪佳玮, 杨刚, 付金松, 等. 术前三维重建联合荧光染色法在单孔胸腔镜肺段切除术中的应用. 局解手术学杂志, 2022, 31(8): 717-720.Wang JW, Yang G, Fu JS, et al. Application of preoperative three-dimensional reconstruction combined with fluorescence staining in single-port thoracoscopic segmentectomy. J Reg Anat Oper Surg, 2022, 31(8): 717-720.
15. 孙云刚, 张强, 王朝, 等. 荧光法在单孔胸腔镜解剖性肺段切除术中识别段间交界线的可行性研究. 中国肺癌杂志, 2021, 24(11): 756-763.Sun YG, Zhang Q, Wang C, et al. Feasibility investigation of fluorescence method in uniport thoracoscopic anatomical segmentectomy for identifying the intersegmental boundary line. Chin J Lung Cancer, 2021, 24(11): 756-763.
16. 胡敏. 吲哚菁绿荧光法在胸腔镜肺段切除术中的应用. 皖南医学院, 2022.Hu M. Application of indocyanine green fluorescence in thoracoscopic segmental pulmonary surgery. Wannan Medical College. 2022.
17. 丁吉, 束余声, 陈勇, 等. 荧光染色法与膨胀-萎陷法在非小细胞肺癌肺段切除术中的对比研究. 中外医学研究, 2022, 20(17): 67-70.Ding J, Shu YS, Chen Y, et al. Comparative study of fluorescence staining and dilatation-collapse in segmentectomy of non small cell lung cancer. Chin Foreign Med Res, 2022, 20(17): 67-70.
18. 曹珲, 侍晔, 董长青, 等. 荧光反染法与膨胀萎陷法在单孔胸腔镜肺段切除术中的应用效果观察. 中国医刊, 2022, 57(1): 96-98.Cao H, Si Y, Dong CQ, et al. Observation of the application effect of fluorescence counterstaining and expansion collapse method in single port thoracoscopic pulmonary segmentectomy. Chin J Med, 2022, 57(1): 96-98.
19. Kamel MK, Rahouma M, Lee B, et al. Segmentectomy is equivalent to lobectomy in hypermetabolic clinical stage ⅠA lung adenocarcinomas. Ann Thorac Surg, 2019, 107(1): 217-223.
20. Tsubokawa N, Tsutan Y, Miyata Y, et al. Segmentectomy versus lobectomy for radiologically pure solid clinical T1a-bN0M0 lung cancer. World J Surg, 2018, 42(8): 2493-2501.
21. Yao F, Wang J, Yao J, et al. Three-dimensional image reconstruction with free open-source OsiriX software in video-assisted thoracoscopic lobectomy and segmentectomy. Int J Surg, 2017, 39: 16-22.
22. 王黎彬, 戚维波. 三维重建及虚拟手术规划在胸腔镜解剖性肺段切除术中的应用进展. 浙江医学, 2019, 41(5): 485-486, 491.Wang LB, Qi WB. Progress of 3D reconstruction and virtual surgical planning in the endoscopic anatomical segmentectomy. Zhejiang Med J, 2019, 41(5): 485-486, 491.
23. 尤培林, 陈文树, 赵力澜, 等. 三维重建在单操作孔胸腔镜肺段切除术治疗早期非小细胞肺癌中的应用: 一项倾向性评分匹配研究. 肿瘤防治研究, 2021, 48(4): 387-392.Long PL, Chen WS, Zhao LL, et al. Application of three-dimensional reconstruction in single utility-port thoracoscopic segmentectomy for early stage non-small cell lung cancer: A propensity scorematched analysis. Cancer Res Prev Treat, 2021, 48(4): 387-392.
24. Andolfi M, Potenza R, Seguin-Givelet A, et al. Identification of the intersegmental plane during thoracoscopic segmentectomy: State of the art. Inter Cardiovasc Thorac Surg, 2020, 30(3): 329-336.
25. Onodera K, Suzuki J, Miyoshi T, et al. Comparison of various lung intersegmental plane identification methods. Gen Thorac Cardiovasc Surg, 2023, 71(2): 90-97.
26. Zhang X, Li C, Jin R, et al. Intraoperative identification of the intersegmental plane: From the beginning to the future. Front Surg, 2022, 9: 948878.
27. Yotsukura M, Okubo Y, Yoshida Y, et al. Indocyanine green imaging for pulmonary segmentectomy. JTCVS Techniques, 2021, 6: 151-158.
28. Wang J, Xu X, Wen W, et al. Modified method for distinguishing the intersegmental border for lung segmentectomy. Thorac Cancer, 2018, 9(2): 330-333.
29. Motono N, Iwai S, Funasaki A, et al. Low-dose indocyanine green fluorescence-navigated segmentectomy: Prospective analysis of 20 cases and review of previous reports. J Thorac Dis, 2019, 11(3): 702-707.
30. 王保明, 吴峰, 马冬春, 等. 基于倾向性评分匹配法的荧光法与改良膨胀-萎陷法解剖性肺段切除术的近期效果比较. 中华胸心血管外科杂志, 2023, 39(3): 134-141.Wang BM, Wu F, Ma DC, et al. Comparison of short-term outcomes between fluorescence method versus modified inflation-deflation method on thoracoscopic anatomical segmentectomy: A study based on propensity score matching. Chin J Thorac Cardiovasc Surg, 2023, 39(3): 134-141.
31. Watanabe A, Ohori S, Nakashima S, et al. Feasibility of video-assisted thoracoscopic surgery segmentectomy for selected peripheral lung carcinomas. Eur J Cardiothorac Surg, 2009, 35(5): 775-780.
32. Iizuka S, Kuroda H, Yoshimura K, et al. Predictors of indocyanine green visualization during fluorescence imaging for segmental plane formation in thoracoscopic anatomical segmentectomy. J Thorac Dis, 2016. , 8(5): 985-991.
33. Tang J. Effect and long-term outcomes of indocyanine green gluorescence imaging method versus modified inflation-Deflation method in identification of intersegmental plane(IMPLANE-0529). URL: https://clinicaltrials.gov/study/NCT05453721?term=NCT05453721&rank=1. 2022.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Indocyanine green fluorescence versus modified inflation-deflation method in thoracoscopic anatomic segmentectomy: A systematic review and meta-analysis

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