Decision for Preservation or Ligation of Aberrant Left Hepatic Artery Using Fluorescence Imaging in Minimally Invasive Gastrectomy: A Prospective Non-randomized Comparative Study
In brief
ICG fluorescence safely guides aberrant hepatic artery ligation in gastrectomy
In a prospective study of 50 minimally invasive gastrectomies, surgeons used near-infrared ICG imaging after temporary clamping of the aberrant left hepatic artery to assess left-lobe perfusion. Patients with partial or complete fluorescence defects had the artery ligated, and none developed severe liver complications, with enzyme elevations normalizing within five days. The technique appears to protect liver function, but larger trials are needed to confirm safety across all perfusion patterns.
- Journal
- Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract (Q1)
- Published
- 14 August 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Ji Eun Jung, Shiyeol Jun, Seyeol Oh, In Gyu Kwon, Sung Hoon Noh, Hyoung-Il Kim
- PMID
- 42600732
- DOI
- 10.1016/j.gassur.2026.102554
Why clinicians should know about it
Abstract
BACKGROUND: In radical gastrectomy, an aberrant left hepatic artery(ALHA) preservation should consider both oncologic safety and liver-related complication. This study aimed to develop the algorithm to decide the ALHA preservation or ligation, using near-infrared fluorescence imaging for liver perfusion during surgery. METHODS: This multicenter, prospective, non-randomized comparative study included 50 patients undergoing minimally invasive gastrectomy for gastric cancer. During surgery, indocyanine green(ICG) was injected intravenously after temporarily clamping ALHA, and the liver perfusion of the left hepatic lobe was assessed based on fluorescence imaging. Patients were categorized into three groups based on the extent of the fluorescence defect: No Perfusion(NP), Partial Perfusion(PP) and Complete Perfusion(CP). ALHA was preserved in the NP group and ligated in the PP and CP groups. Postoperative liver dysfunction was evaluated by monitoring changes in liver enzyme levels. RESULTS: Between December, 2021 and June, 2023, 50 patients were enrolled: 15 in the NP group, 12 in the PP group, and 23 in the CP group. No ICG injection-related adverse events were reported. A significant increase in liver enzyme levels was observed in the PP group. Specifically, AST changes differed significantly among the NP, PP, and CP groups on postoperative day(POD)1(95.95±104.5%,303.73±383.4%,109.39±99.6%; p=0.049) and POD5(-12.43±31.1%,7.63±16.5%,-19.51±22.1%; p=0.037). ALT changes also differed on POD3(27.73±58.5%,313.68±417.1%,127.68±176.9%; p=0.036) and POD5(8.19±52.9%,185.47±148.3%,32.43±77.1%; p=0.004). All liver enzyme levels normalized within five days postoperatively, and no severe liver-related complications were observed up to one month after surgery. Although ALHA diameter differed among the perfusion groups, ALHA subtype distribution was similar across the groups. CONCLUSION: Real-time near-infrared fluorescence imaging safely guided ALHA management during gastrectomy by evaluating hepatic perfusion, minimizing liver dysfunction risk. However, further studies are required to evaluate the safety of ALHA ligation across all perfusion patterns. TRIAL REGISTRATION NUMBER: NCT05971069.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.