Identification of Hepatocellular Carcinoma Recurrence after Resection

  • Yoshikuni Kawaguchi
  • Kosuke Kobayashi
  • Kiyoshi HasegawaEmail author


Fluorescence imaging technique using indocyanine green (ICG) as a fluorophore has been increasingly used for many surgical procedures since the 2000s. Because ICG is taken into hepatocyte and exclusively excreted into the bile, the technique is used for hepatobiliary surgery. ICG-fluorescence imaging visualizes the flow of hepatic artery and portal vein, primary and metastatic liver tumors, the bile duct, and portal venous territory. The technique is also used for evaluating hepatic perfusion in regions with outflow obstruction. Liver resection is the optimal treatment option for hepatocellular carcinoma (HCC), and fluorescence imaging guides surgeons for identifying HCC during surgery in real time. Although cumulative recurrence rates after HCC resection remain high, repeat hepatectomy was reported to lead better cumulative long-term survival from initial resection. The problem of repeat hepatectomy lies in technical complexity because of adhesions and changes in liver anatomy after previous operation. These changes may hinder surgeons from identifying HCCs in the operating room. Fluorescence imaging is helpful for visualizing HCC recurrence on the thick connective tissue after previous resection because of adhesions after initial liver resection. In conclusion, ICG-fluorescence imaging can be used for visualizing HCC recurrence in patients undergoing repeat hepatectomy as in patients undergoing initial liver resection. The technique may be useful for complementing visual inspection, palpation, and intraoperative ultrasonography.


Fluorescence imaging Indocyanine green Hepatocellular carcinoma Repeat hepatectomy Recurrence 

Supplementary material

Video 15.1

Fluorescence imaging of hepatocellular carcinoma. After mobilization of the liver, a near-infrared camera is placed above left lateral sector of the liver. Two HCCs (arrow and arrowhead) were identified as fluorescence on the surface of the cirrhotic liver (MP4 16200 kb)

Video 15.2

Fluorescence imaging of recurrence of hepatocellular carcinoma. After dissecting adhesions and mobilizing the liver, a near-infrared camera is placed above segment 6. HCC is visualized as fluorescence on the thick connective tissue of the liver surface. Another HCC in segment 4 is also identified as fluorescence on the liver surface (MP4 37523 kb)


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Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Yoshikuni Kawaguchi
    • 1
  • Kosuke Kobayashi
    • 1
  • Kiyoshi Hasegawa
    • 1
    Email author
  1. 1.Hepato-Biliary-Pancreatic Surgery Division, Department of SurgeryGraduate School of Medicine, The University of TokyoTokyoJapan

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