Feasibility, Safety, and Early Outcomes of Image-Guided Segmentectomy Using Near-Infrared Fluorescence Dye for Tumor Visualization and Margin Identification: A Collaborative Effort by the Surgical and Radiological Teams

Introduction: Despite advances in lung cancer management, it remains the leading cause of cancer-related deaths. Low-dose computed tomography (LDCT) screening has increased detection of small, difficult-to-palpate lung lesions. Materials and Methods: This retrospective study at Chang Gung Memorial Hospital (2014–2022) evaluated the feasibility of image-guided segmentectomy (I-segmentectomy) using indocyanine green (ICG) for lesion localization and intersegmental plane navigation. Results: A total of 260 patients with 266 pulmonary lesions were enrolled in the study cohort, with 122 lesions undergoing image-guided segmentectomy (I-segmentectomy). After propensity score matching, lesions resected using the I-segmentectomy method provided appropriate resection margins and margin-to-tumor ratios, particularly for lesions larger than 1 cm. Additionally, operation times were shorter with I-segmentectomy. Survival analysis showed no significant differences in disease-free and overall survival; although I-segmentectomy maintained a 100% survival rate. Conclusion: Overall, I-segmentectomy with dual ICG fluorescence imaging is a feasible, safe, and effective method for ensuring adequate resection margins in difficult-to-discern lung lesions. Further prospective studies are necessary to validate these findings and assess long-term outcomes.