DOI: https://doi.org/10.14710/dmj.v13i4.44956

Comparison of Intravenous Indocyanine-Green and Inflation-Deflation Method in Lung Segmentectomy: A Meta-Analysis

*Haidar Ali Robbani Al Asrory orcid  -  faculty of medicine, Airlangga University, Indonesia
Hana Imania orcid  -  faculty of medicine, Airlangga University, Indonesia

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Abstract
Background: Inflation-deflation technique had been a conventional method for delineating the intersegmental plane during lung segmentectomy. Over the last decade, the use of icg has shown a significant increase as an alternative method. According to the European Society of Thoracic Surgeons' (ESTS) newly released expert consensus recommendations, Systemic ICG is the preferred method for performing ISP delineation. Objective: This study aimed to determine the safety of intravenous ICG in lung segmentectomy compared to inflation-deflation method. Methods: PubMed, Science direct, and Scilit were systematically reviewed. Studies comparing ICG with inflation-deflation method in lung segmentectomy were included. The main outcome included operation time while blood loss, length of hospital stay, and air leakage event became secondary. Odd Ratio (OR) and Mean Difference (MD) with 95% of Confidence Interval (CI) were applied for dicotomous and continous variable, respectively. Heterogeneity was assessed using Cochrane Q and I statistics, as reviewers also manually tested for heterogeneity with sensitivity analysis. Results: Six studies with a total of 839 patients were retrieved. All of them were retrospective comparative studies, mainly with a diagnosis of pulmonary nodules. Most studies utilized peripheral vein injections of 2.5 mg/mL ICG solution, which had a dosage range of 3–10 mL. Intravenous ICG administration was associated with a noticable operation time [MD = -19.30, 95% CI -28.29 to -10.31, p < 0.00001], length of hospital stay [MD = -0.61; 95% CI -1.16 to -0.06, p = 0.03], as well as a significant OR observed in the number air leakage [OR = 0.39; 95% CI 0.20 to 0.75, p = 0.005]. Meanwhile, there was no significant difference in the amount of bleeding between the inflation-deflation group and the ICG group [MD = -5.18, 95% CI -12.08 to 1.72, p = 0.14]. Conclusion: This meta-analysis has demonstrated statistically that the duration of surgery, length of hospital stay, and the probability of postoperative air leak are significantly lower with the application of ICG in lung segmentectomy.
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Keywords: Indocyanine-green, Inflation-deflation, Lung, Segmentectomy, Surgery

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  1. Logan CD, Jacobs RC, Feinglass J, et al. National trends in the quality of segmentectomy for lung cancer. J Thorac Cardiovasc Surg. 2023; 165(1): 351-363.e20. doi: 10.1016/j.jtcvs.2022.05.050
  2. Ueno H, Setogawa T, Makita A, et al. Influencing Factors on Intersegmental Identification Adequacy in Segmentectomy with Intraoperative Indocyanine Green (ICG) Intravenous Administration. Cancers (Basel). 2023; 15(24): 5876. doi: 10.3390/cancers15245876
  3. Charloux A, Quoix E. Lung segmentectomy: does it offer a real functional benefit over lobectomy?. Eur Respir Rev. 2017; 26(146): 170079. doi: 10.1183/16000617.0079-2017
  4. Fan W, Yang H, Ma J, Wang Z, Zhao H, Yao F. 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. doi: 10.21037/jtd-22-292
  5. Mun M, Okumura S, Nakao M, Matsuura Y, Nakagawa K. Indocyanine green fluorescence-navigated thoracoscopic anatomical segmentectomy. J Vis Surg. 2017; 3: 80. doi: 10.21037/jovs.2017.05.06
  6. Sienel W, Dango S, Kirschbaum A, Cucuruz B, Horth W, Stremmel C et al. Sublobar resections in stage IA non-small cell lung cancer: segmentectomies result in significantly better cancer-related survival than wedge resections. Eur J Cardiothorac Surg 2008; 33: 728–34
  7. Kim HE, Yang YH, Lee CY. Video-Assisted Thoracic Surgery Segmentectomy. J Chest Surg. 2021; 54(4): 246-252. doi: 10.5090/jcs.21.058
  8. Chen R, Ma Y, Li C, et al. A Pilot Study of Pulmonary Segmentectomy With Indocyanine Green Near-Infrared Angiography. Surg Innov. 2019; 26(3): 337-343. doi: 10.1177/1553350618824914
  9. Wada H, Yamamoto T, Morimoto J, et al. Near-Infrared-Guided Pulmonary Segmentectomy After Endobronchial Indocyanine Green Injection. Ann Thorac Surg. 2020; 109(2): 396-403 doi: 10.1016/j.athoracsur.2019.08.083
  10. Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021; 372: n71. Published 2021 Mar 29. doi: 10.1136/bmj.n71
  11. Wells G, Shea B, O’connell D, Peterson J,Welch V. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomized studies in meta-analyses. 3rd Symposium on Systematic Reviews: Beyond the Basics. 2000: 3–5
  12. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003; 327(7414): 557–60. doi: 10.1136/bmj.327.7414.557
  13. Mantel N, Haenszel W. Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst. 1959; 22(4): 719–48
  14. DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986; 7(3): 177–88. doi: 10.1016/0197-2456(86)90046-2
  15. Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics. 1994; 50(4):1088–101
  16. Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997; 315(7109): 629–34. doi: 10.1136/bmj.315.7109.629
  17. Review Manager (RevMan) [Computer program]. Version 5.4. The Cochrane Collaboration, 2020
  18. Bae SY, Yun T, Park JH, et al. Comparative Study of Indocyanine Green Intravenous Injection and the Inflation-Deflation Method for Assessing Resection Margins in Segmentectomy for Lung Cancer: A Single-Center Retrospective Study. J Chest Surg. Published online April 23, 2024. doi: 10.5090/jcs.24.008
  19. Feng S, Yungang S, Zhao W, Zhengcheng L, Hui C, Ye S, Rusong Y. Comparative study of fluorescence and inflation-deflation methods in defining the intersegmental plane in thoracoscopic anatomical lung segmentectomy. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery. 2019; (12): 899-904
  20. Huang JX, Chen Q, Hong SM, Hong JJ. Comparison of ICG-Guided Near-Infrared Fluorescence Imaging and Modified Inflation-Deflation Method in Identifying the Intersegmental Plane During Lung Segmentectomy of Infants. J Pediatr Surg. Published online April 9, 2024. doi: 10.1016/j.jpedsurg.2024.03.061
  21. 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(1):303. doi: 10.1186/s13019-020-01310-z
  22. Sun Y, Zhang Q, Wang Z, Shao F, Yang R. Feasibility investigation of near-infrared fluorescence imaging with intravenous indocyanine green method in uniport video-assisted thoracoscopic anatomical segmentectomy for identifying the intersegmental boundary line [published correction appears in Thorac Cancer. 2022 Jun;13(11):1748]. Thorac Cancer. 2021;12(9):1407-1414. doi: 10.1111/1759-7714.13923
  23. Schreve MA, Vos CG, Vahl AC, et al. Venous Arterialisation for Salvage of Critically Ischaemic Limbs: A Systematic Review and Meta-Analysis. Eur J Vasc Endovasc Surg. 2017;53(3):387-402. doi: 10.1016/j.ejvs.2016.11.007
  24. Wang J, Xu X, Wen W, Wu W, Zhu Q, Chen L. Modified method for distinguishing the intersegmental border for lung segmentectomy. Thorac Cancer. 2018; 9(2): 330-333. doi: 10.1111/1759-7714.12540
  25. Cui F, Liu J, Du M, et al. Expert consensus on indocyanine green fluorescence imaging for thoracoscopic lung resection (The Version 2022). Transl Lung Cancer Res. 2022; 11(11): 2318-2331. doi: 10.21037/tlcr-22-810
  26. Misaki N, Chang SS, Igai H, Tarumi S, Gotoh M, Yokomise H. New clinically applicable method for visualizing adjacent lung segments using an infrared thoracoscopy system. J Thorac Cardiovasc Surg. 2010;140:752–6. doi: 10.1016/j.jtcvs.2010.07.020
  27. Tarumi S, Misaki N, Kasai Y, Chang SS, Go T, Yokomise H. Clinical trial of video-assisted thoracoscopic segmentectomy using infrared thoracoscopy with indocyanine green. Eur J Cardiothorac Surg. 2014;46(1):112-115. doi: 10.1093/ejcts/ezt565
  28. Ito A, Takao M, Shimamoto A, Shimpo H. Prolonged intravenous indocyanine green visualization by temporary pulmonary vein clamping: real-time intraoperative fluorescence image guide for thoracoscopic anatomical segmentectomy. Eur J Cardiothorac Surg. 2017;52:1225–6. doi: 10.1093/ejcts/ezx233
  29. Pischik VG, Kovalenko A. The role of indocyanine green fluorescence for intersegmental plane identification during video-assisted thoracoscopic surgery segmentectomies. J Thorac Dis. 2018; 10(Suppl 31): S3704-S3711. doi: 10.21037/jtd.2018.04.84
  30. Yotsukura M, Okubo Y, Yoshida Y, Nakagawa K, Watanabe SI. Indocyanine green imaging for pulmonary segmentectomy. JTCVS Tech. 2021; 6: 151-158. doi: 10.1016/j.xjtc.2020.12.005
  31. Jin Y, Wang M, Xue L, Zhao X. Clinical Application of Near-Infrared Thoracoscopy With Indocyanine Green in Video-Assisted Thoracoscopic Anatomical Segmentectomy [published correction appears in Surg Innov. 2020 Oct;27(5):555]. Surg Innov. 2019; 26(4): 473-477. doi: 10.1177/1553350619848197
  32. Motono N, Iwai S, Funasaki A, Sekimura A, Usuda K, Uramoto H. 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. doi: 10.21037/jtd.2019.02.70
  33. Meacci E, Nachira D, Congedo MT, Chiappetta M, Petracca Ciavarella L, Margaritora S. Uniportal video-assisted thoracic lung segmentectomy with near infrared/indocyanine green intersegmental plane identification. J Vis Surg. 2018; 4: 17. doi: 10.21037/jovs.2017.12.16
  34. Tokuno J, Chen-Yoshikawa TF, Nakajima D, et al. Improved visualization of virtual-assisted lung mapping by indocyanine green. JTCVS Tech. 2021; 10: 542-549. doi: 10.1016/j.xjtc.2021.07.019
  35. Gkikas A, Lampridis S, Patrini D, Kestenholz PB, Scarci M, Minervini F. How effective is indocyanine green (ICG) in localization of malignant pulmonary nodules? A systematic review and meta-analysis. Front Surg. 2022; 9: 967897. doi: 10.3389/fsurg.2022.967897
  36. Li X, Zeng Y, Liu J, Cui F, He J. Indocyanine Green Remains in the Lung for up to 6 Days. Ann Thorac Surg. 2020; 110(5): e385-e386. doi: 10.1016/j.athoracsur.2020.03.076
  37. Peeters M, Jansen Y, Daemen JHT, et al. The use of intravenous indocyanine green in minimally invasive segmental lung resections: a systematic review. Transl Lung Cancer Res. 2024; 13(3): 612-622. doi: 10.21037/tlcr-23-807
  38. Reeves JJ, Broderick RC, Lee AM, et al. The price is right: Routine fluorescent cholangiography during laparoscopic cholecystectomy. Surgery. 2022; 171(5): 1168-1176. doi: 10.1016/j.surg.2021.09.027
  39. Brunelli A, Decaluwe H, Gonzalez M, et al. European Society of Thoracic Surgeons expert consensus recommendations on technical standards of segmentectomy for primary lung cancer. Eur J Cardiothorac Surg 2023; 63: ezad224
  40. 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. doi: 10.21037/jtd.2016.03

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