Near-Infrared Fluorescence Imaging with Indocyanine Green for Robot-Assisted Partial Nephrectomy: A Systematic Review and Meta-Analysis

Simple Summary Renal cell cancer, constituting the predominant type of kidney malignancy, exhibits a global annual incidence increase of 2%. In the management of clinical T1 renal tumors, the recommended surgical approach is partial nephrectomy (PN). The primary objective of this procedure is the preservation of nephrons, thereby mitigating the risk of enduring kidney dysfunction and maintaining comparable oncological outcomes when contrasted with radical nephrectomy. Initially performed as an open surgery, PN has undergone significant evolution, with minimally invasive techniques, particularly robot-assisted ones, garnering recognition. Nonetheless, despite the inherent advantages, partial nephrectomy presents specific challenges, notably an elevated likelihood of incomplete tumor excision and positive surgical margins, which may have implications for cancer-specific outcomes. To address these challenges, the utilization of near-infrared fluorescence technology, involving the intravenous administration of indocyanine green (ICG), has been proposed. ICG, a water-soluble compound that binds to plasma albumin, emits near-infrared light, enabling the visualization of kidney vasculature and renal tumors.Abstract Background: We aimed to analyze the influence of near-infrared fluorescence (NIRF) using indocyanine green (ICG) with standard robot-assisted partial nephrectomy (RAPN) in patients with a kidney tumor (KT). Methods: We performed a literature search on 12 September 2023 through PubMed, EMBASE, and Scopus. The analysis included observational studies that examined the perioperative and long-term outcomes of patients with a KT who underwent RAPN with NIRF. Results: Overall, eight prospective studies, involving 535 patients, were eligible for this meta-analysis, with 212 participants in the ICG group and 323 in the No ICG group. For warm ischemia time, the ICG group showed a lower duration (weighted Mean difference (WMD) = -2.05, 95% confidence interval (CI) = -3.30--0.80, p = 0.011). The postoperative eGFR also favored the ICG group (WMD = 7.67, 95% CI = 2.88-12.46, p = 0.002). No difference emerged for the other perioperative outcomes between the two groups. In terms of oncological radicality, the positive surgical margins and tumor recurrence rates were similar among the two groups. Conclusions: Our meta-analysis showed that NIRF with ICG during RAPN yields a favorable impact on functional outcomes, whereas it exerts no such influence on oncological aspects. Therefore, NIRF should be adopted when preserving nephron function is a paramount concern.