Home›Oncology› ICG fluorescence imaging linked to 92.5% patient-level R0 resection in colorectal liver metastases
ICG fluorescence imaging linked to 92.5% patient-level R0 resection in colorectal liver metastasesICG Fluorescence Imaging Helps Surgeons Navigate Liver Cancer Surgery
Surgical endoscopyPublished October 4, 2026Study authors: Han Fengjie, Wang Qingqing, Shu GuimingPubMed ↗DOI ↗Editorial oversight: Dr. Julia Lee, PhD · Oncology, Genomics & Drug Development
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Key Takeaway
Consider ICG for margin navigation in CRLM, but comparative benefit is unproven.
This meta-analysis synthesized evidence on indocyanine green (ICG) fluorescence imaging for lesion visualization and margin-oriented navigation in patients with colorectal liver metastases (CRLM) undergoing minimally invasive liver resection. The scope covered R0 resection at patient and lesion level, major morbidity, and fluorescence-positive proportions.
Pooled patient-level R0 resection was 92.5% (146/155; 95% CI 62.7-98.9%) and lesion-level R0 was 93.0% (424/455; 95% CI 83.2-97.3%). Major morbidity (Clavien-Dindo grade III or higher) was 6.2% (20/354; 95% CI 3.1-11.8%). In the one controlled comparison, lesion-level R0 was higher with ICG (odds ratio 5.65; 95% CI 1.02-31.48).
The authors note several limitations. The controlled comparison was small and retrospective. Reference standards and outcome definitions for fluorescence-positive proportions were heterogeneous. They conclude there is insufficient evidence to establish comparative benefit over conventional minimally invasive resection.
Safety data, including adverse events, serious adverse events, discontinuations, and tolerability, were not reported. Follow-up duration was not reported. Funding and conflicts of interest were not reported.
Practice relevance is limited to feasibility: ICG fluorescence imaging appears feasible for lesion visualization and margin-oriented navigation in selected CRLM patients at experienced centers. The evidence does not support a claim of comparative benefit over conventional methods.
How this fits prior evidence
This meta-analysis extends prior coverage of intraoperative ICG in colorectal surgery, where ICG fluorescence angiography improved bowel perfusion assessment, by shifting the focus to oncologic margin navigation in CRLM. It also aligns with prior evidence that R1 vascular margin is not acceptable for CLM in minimally invasive liver surgery, reinforcing margin-oriented strategies. The reported 92.5% patient-level R0 resection is consistent with feasibility, but the small retrospective controlled comparison (odds ratio 5.65; 95% CI 1.02-31.48) does not establish comparative benefit, leaving a gap relative to prior SBRT local control data.
Researchers analyzed data from 155 patients with colorectal liver metastases who underwent minimally advance surgery. The study looked at how indocyanine green (ICG) fluorescence imaging helps surgeons see and remove tumors more effectively. The results showed a 92.5% success rate for clear surgical margins at the patient level and a 93.0% success rate at the lesion level.
A small, retrospective comparison also suggested that using ICG might lead to higher rates of clear margins compared to standard methods. However, the researchers noted that the evidence is currently limited. Because the comparison was small and the data was gathered from different sources, it is not yet clear if ICG is significantly better than standard surgical techniques.
For patients, this means that ICG is a feasible tool for surgeons to use when navigating and visualizing tumors during surgery. However, because the study is small and the evidence is not yet definitive, it is not yet a standard replacement for current methods. Patients should discuss these surgical technologies with their medical team to understand how they might apply to their specific case.
What this means for you:
ICG imaging helps surgeons see tumor margins, but more research is needed to prove it is better than standard methods.
Common questions
What is the success rate for removing tumors using ICG imaging?
The study reported a 92.5% success rate for clear surgical margins at the patient level and a 93.0% success rate at the lesion level. These figures indicate that the technology is feasible for helping surgeons navigate and see tumor margins during minimally invasive liver surgery.
Is ICG imaging safer than traditional surgery?
The study reported a major morbidity rate of 6.2% for the procedures involving ICG. However, the data was not sufficient to prove that ICG is safer or more effective than standard surgical methods. You should talk to your surgeon about the specific risks and benefits of this technology.
Is this a proven replacement for standard surgery?
Not yet. While the study shows ICG is a feasible tool for surgeons to use, the evidence is currently too limited to say it is better than standard methods. The comparison study was small and retrospective, meaning more research is needed to confirm its specific benefits.
BACKGROUND: Indocyanine green (ICG) fluorescence imaging is used during minimally invasive liver resection for colorectal liver metastases (CRLM), but disease-specific evidence is limited and has often mixed patient-level and lesion-level outcomes.
METHODS: Six databases were searched to May 14, 2026. We prespecified lesion-detection and surgical-outcome modules. Primary quantitative analyses required fully separable CRLM numerators and denominators. Patient-level and lesion-level R0 outcomes were analyzed separately. Random-effects logit models used Paule-Mandel variance and Hartung-Knapp 95% confidence intervals (CIs). Diagnostic studies were assessed with QUADAS-2 and surgical cohorts with the Newcastle-Ottawa Scale.
RESULTS: Eighteen eligible reports represented 17 unique cohorts; one earlier report was excluded from quantitative synthesis because its cohort was nested in a later study. Patient-level R0 resection was reported in four studies (146/155 patients) and pooled at 92.5% (95% CI 62.7-98.9%; I = 71.3%). Lesion-level R0 resection was reported in four studies (424/455 lesions) and pooled at 93.0% (95% CI 83.2-97.3%; I = 25.3%). Major morbidity (Clavien-Dindo grade III or higher) occurred in 20/354 patients across four CRLM-specific cohorts, with a pooled proportion of 6.2% (95% CI 3.1-11.8%; I = 0%). Six studies reported fluorescence-positive proportions for CRLM lesions ranging from 59.6 to 95.6%; these were not pooled because reference standards and outcome definitions differed. The only controlled comparison reported higher lesion-level R0 with ICG (odds ratio 5.65, 95% CI 1.02-31.48), but was small and retrospective.
CONCLUSIONS: ICG fluorescence imaging is feasible for lesion visualization and margin-oriented navigation in selected CRLM patients at experienced centers. Evidence remains insufficient to establish comparative benefit over conventional minimally invasive resection. Adequately powered randomized trials with standardized ICG and intraoperative-ultrasonography protocols and patient-centered oncologic outcomes are essential.
TRIAL REGISTRATION: PROSPERO registration: CRD420261394514.
