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Objective <p>This study aimed to evaluate the clinical value of indocyanine green (ICG) fluorescence imaging navigation-guided thoracoscopic surgery for the treatment of intralobar pulmonary sequestration (ILS), comparing it with traditional anatomical lobectomy. The focus was on analyzing its advantages in precise lesion resection, preservation of normal lung parenchyma, perioperative outcomes, and mid-term pulmonary function protection.</p> Methods <p>We retrospectively analyzed data from 45 consecutive ILS patients who underwent surgery by the same surgical team at our institution between January 2010 and July 2025. Based on the surgical approach, patients were divided into two groups: the traditional group (n = 19) underwent VATS anatomical lobectomy; the ICG group (n = 26) received intravenous ICG injection (0.25&#xa0;mg/kg) after ligation of the aberrant systemic feeding artery, and the near-infrared fluorescence imaging system was used to delineate the perfusion defect area, guiding the surgical strategy. Baseline characteristics, perioperative outcomes, stress and inflammatory markers on postoperative day 3, and changes in pulmonary function at 6&#xa0;months postoperatively were compared between the two groups.</p> Results <p>There were no statistically significant differences in baseline data between the two groups (P &gt; 0.05). The ICG group showed significantly superior outcomes compared to the traditional group in terms of operative time (53.7 ± 15.1&#xa0;min vs. 105.5 ± 26.2&#xa0;min), intraoperative blood loss (86.3 ± 23.9&#xa0;mL vs. 176.4 ± 53.5&#xa0;mL), thoracic drainage volume (533.6 ± 124.7&#xa0;mL vs. 865.5 ± 183.8&#xa0;mL), drainage duration (4.2 ± 1.3 d vs. 5.4 ± 1.8 d), and postoperative hospital stay (5.3 ± 1.1 d vs. 6.2 ± 1.6 d) (all P &lt; 0.05). On the 3rd postoperative day, the serum levels of cortisol, adrenocorticotropic hormone (ACTH), interleukin-6 (IL-6), and C-reactive protein (CRP) in the ICG group were significantly lower than those in the traditional group (all P &lt; 0.001). There was no statistically significant difference in the incidence of postoperative complications between the two groups (P = 0.75), and no perioperative mortality was observed. At 6&#xa0;months postoperatively, the ICG group exhibited a smaller decline in pulmonary function: ΔFVC (0.3 ± 0.1 L vs. 0.5 ± 0.4 L, P = 0.02), ΔFEV1 (0.2 ± 0.1 L vs. 0.4 ± 0.3 L, P &lt; 0.01), and ΔDLCO% (4.5 ± 0.6% vs. 13.5 ± 3.7%, P &lt; 0.001).</p> Conclusions <p>By visualizing the functional boundary based on blood perfusion, ICG-guided sublobar resection can safely and accurately guide surgical decision-making for ILS, effectively addressing the dilemma of over-resection or under-resection in traditional anatomical resection. Compared with traditional lobectomy, this technique significantly reduces surgical trauma and stress, promotes postoperative recovery, and maximizes the preservation of mid-term pulmonary function without increasing the risk of complications. Therefore, for ILS patients with localized lesions and no irreversible fibrosis or consolidation of surrounding lung tissue, ICG-guided precise lung parenchyma preserving surgery should be regarded as the preferred surgical strategy.</p>

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Comparison of indocyanine green fluorescence-guided sublobar resection versus conventional anatomical lobectomy for intralobar pulmonary sequestration: a retrospective cohort study

  • 期刊论文

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  • 发表日期：

    2026年6月26日

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  • Wenhao Wang,
  • Yulong Tan,
  • Yifeng Qian,
  • Kaile Jiang,
  • Meng Shi,
  • Xiaofeng Chen

摘要

Objective

This study aimed to evaluate the clinical value of indocyanine green (ICG) fluorescence imaging navigation-guided thoracoscopic surgery for the treatment of intralobar pulmonary sequestration (ILS), comparing it with traditional anatomical lobectomy. The focus was on analyzing its advantages in precise lesion resection, preservation of normal lung parenchyma, perioperative outcomes, and mid-term pulmonary function protection.

Methods

We retrospectively analyzed data from 45 consecutive ILS patients who underwent surgery by the same surgical team at our institution between January 2010 and July 2025. Based on the surgical approach, patients were divided into two groups: the traditional group (n = 19) underwent VATS anatomical lobectomy; the ICG group (n = 26) received intravenous ICG injection (0.25 mg/kg) after ligation of the aberrant systemic feeding artery, and the near-infrared fluorescence imaging system was used to delineate the perfusion defect area, guiding the surgical strategy. Baseline characteristics, perioperative outcomes, stress and inflammatory markers on postoperative day 3, and changes in pulmonary function at 6 months postoperatively were compared between the two groups.

Results

There were no statistically significant differences in baseline data between the two groups (P > 0.05). The ICG group showed significantly superior outcomes compared to the traditional group in terms of operative time (53.7 ± 15.1 min vs. 105.5 ± 26.2 min), intraoperative blood loss (86.3 ± 23.9 mL vs. 176.4 ± 53.5 mL), thoracic drainage volume (533.6 ± 124.7 mL vs. 865.5 ± 183.8 mL), drainage duration (4.2 ± 1.3 d vs. 5.4 ± 1.8 d), and postoperative hospital stay (5.3 ± 1.1 d vs. 6.2 ± 1.6 d) (all P < 0.05). On the 3rd postoperative day, the serum levels of cortisol, adrenocorticotropic hormone (ACTH), interleukin-6 (IL-6), and C-reactive protein (CRP) in the ICG group were significantly lower than those in the traditional group (all P < 0.001). There was no statistically significant difference in the incidence of postoperative complications between the two groups (P = 0.75), and no perioperative mortality was observed. At 6 months postoperatively, the ICG group exhibited a smaller decline in pulmonary function: ΔFVC (0.3 ± 0.1 L vs. 0.5 ± 0.4 L, P = 0.02), ΔFEV1 (0.2 ± 0.1 L vs. 0.4 ± 0.3 L, P < 0.01), and ΔDLCO% (4.5 ± 0.6% vs. 13.5 ± 3.7%, P < 0.001).

Conclusions

By visualizing the functional boundary based on blood perfusion, ICG-guided sublobar resection can safely and accurately guide surgical decision-making for ILS, effectively addressing the dilemma of over-resection or under-resection in traditional anatomical resection. Compared with traditional lobectomy, this technique significantly reduces surgical trauma and stress, promotes postoperative recovery, and maximizes the preservation of mid-term pulmonary function without increasing the risk of complications. Therefore, for ILS patients with localized lesions and no irreversible fibrosis or consolidation of surrounding lung tissue, ICG-guided precise lung parenchyma preserving surgery should be regarded as the preferred surgical strategy.