The clinical value of indocyanine green fluorescence navigation system for laparoscopic partial nephrectomy in the case of complex renal clear cell carcinoma (R.E.N.A.L score ≥7)

Objective: We demonstrated the potential clinical utility of the indocyanine green (ICG) fluorescence navigation system for laparoscopic partial nephrectomy in the case of complex renal clear cell carcinoma (R.E.N.A.L score ≥7). Methods: Compared with the general laparoscopic partial nephrectomy and ICG fluorescence laparoscopic partial nephrectomy, a series of indicators were analyzed: the basic information like age, sex, and the tumor location; the operative information like the time of renal ischemia, the blood loss, and the complications; and other important indexes like the renal function, the volume of the tumor, and the weight of the specimens. Results: 60 patients were included in this study. 21 patients in the group of fluorescence laparoscopy, and 39 patients in the group of general laparoscopy. There was no statistical difference for most indexes except the renal function. Preoperative serum creatinine was close (82.4±11.7 vs. 77.5±12.7, mmol/l, p=0.15). However, the patients in the group of fluorescence laparoscopy got a smaller serum creatinine growth degree (12.9±5.3 vs. 17.9±7.3, mmol/l, p=0.008), and a less decreasing level of GFR (16.5±6.4 vs. 24.4±9.8, mL/(min*1.73m(2)), p=0.001) after the operation. In addition, the average volume of the tumor (28.8±9.8 vs. 26.9±8.2, cm(3), p=0.43) and the weight of the specimens (32.3±10.4 vs. 33.9±8.9, g, p=0.52) were no statistical difference. But the group of fluorescence laparoscopy had a smaller ratio of the weight/ the volume (1.13±0.06 vs. 1.28±0.10, g/cm(3), p<0.001). And the two groups had a similar test-positivity rate of surgical margins (p=0.19). Conclusion: Without increasing the rate of positive surgical margins, ICG fluorescence navigation system for laparoscopic partial nephrectomy for complex renal clear cell carcinoma could conserve more normal renal tissue.