World J Surg. 2021 Dec;45(12):3660-3667. doi: 10.1007/s00268-021-06289-9. Epub 2021 Aug 14.

Predicting Post-Hepatectomy Liver Failure Using Intra-Operative Measurement of Indocyanine Green Clearance in Anatomical Hepatectomy.

World journal of surgery

Naoya Sato, Akira Kenjo, Seiko Suzushino, Takashi Kimura, Ryo Okada, Teruhide Ishigame, Yasuhide Kofunato, Shigeru Marubashi

PMID: 34392399 DOI: 10.1007/s00268-021-06289-9

Abstract

BACKGROUND: Prediction of post-hepatectomy liver failure (PHLF) based on remnant liver function reserve is important for successful hepatectomy. The aim of this study was to investigate whether intraoperative indocyanine green (ICG) clearance in a future remnant liver was a predictor of PHLF.

METHODS: This prospective study enrolled 31 consecutive patients who underwent anatomical hepatectomy between June 2016 and August 2019. Intraoperative ICG plasma disappearance rate (ICG-PDR) and ICG retention rate at 15 min (ICG-R15) were measured after clamping the selective hepatic inflow to the liver to be resected. The discriminative performance of the ICG-associated variables for the prediction of PHLF grade B/C was evaluated by receiver operator curve (ROC) analysis.

RESULTS: Of the operations performed, 87.1% were major hepatectomy. PHLF Grade B/C was observed in eight patients (25.8%) with no mortality. The concordance indices of intraoperative ICG-PDR and ICG-PDR for predicting PHLF were 0.834 (95% CI, 0.69-0.98) and 0.834 (95% CI, 0.69-0.98), respectively. A subgroup analysis of patients with preoperative biliary drainage (BD) (n = 17) showed that the concordance indices of intraoperative ICG-PDR increased to 0.923 (95% CI, 0.79-1.00).

CONCLUSIONS: Intraoperative ICG clearance in the remnant liver was a promising predictor for PHLF in patients undergoing anatomical hepatectomy, especially in patients with BD.

© 2021. Société Internationale de Chirurgie.

References

1. Balzan S, Belghiti J, Farges O, Ogata S, Sauvanet A, Delefosse D et al (2005) The "50–50 criteria" on postoperative day 5: an accurate predictor of liver failure and death after hepatectomy. Ann Surg 242(6):824–828 - PubMed
2. Mullen JT, Ribero D, Reddy SK, Donadon M, Zorzi D, Gautam S et al (2007) Hepatic insufficiency and mortality in 1,059 noncirrhotic patients undergoing major hepatectomy. J Am Coll Surg 204(5):854–862 - PubMed
3. Capussotti L, Vigano L, Giuliante F, Ferrero A, Giovannini I, Nuzzo G (2009) Liver dysfunction and sepsis determine operative mortality after liver resection. Br J Surg 96(1):88–94 - PubMed
4. Nagino M, Kamiya J, Nishio H, Ebata T, Arai T, Nimura Y (2006) Two hundred forty consecutive portal vein embolizations before extended hepatectomy for biliary cancer: surgical outcome and long-term follow-up. Ann Surg 243(3):364–372 - PubMed
5. Kenjo A, Miyata H, Gotoh M, Kitagawa Y, Shimada M, Baba H et al (2014) Risk stratification of 7,732 hepatectomy cases in 2011 from the National Clinical Database for Japan. J Am Coll Surg 218(3):412–422 - PubMed
6. Liu JY, Ellis RJ, Hu QL, Cohen ME, Hoyt DB, Yang AD et al (2020) Post hepatectomy liver failure risk calculator for preoperative and early postoperative period following major hepatectomy. Ann Surg oncol 27(8):2868–2876 - PubMed
7. Imamura H, Seyama Y, Kokudo N, Maema A, Sugawara Y, Sano K et al (2003) One thousand fifty-six hepatectomies without mortality in 8 years. Arch Surg 138(11):1198–206 - PubMed
8. Yamanaka N, Okamoto E, Oriyama T, Fujimoto J, Furukawa K, Kawamura E et al (1994) A prediction scoring system to select the surgical treatment of liver cancer. Further refinement based on 10 years of use. Ann surg 219(4):342–346 - PubMed
9. Mitsumori A, Nagaya I, Kimoto S, Akaki S, Togami I, Takeda Y et al (1998) Preoperative evaluation of hepatic functional reserve following hepatectomy by technetium-99m galactosyl human serum albumin liver scintigraphy and computed tomography. Eur J Nucl Med 25(10):1377–1382 - PubMed
10. Kwon AH, Matsui Y, Kaibori M, Ha-Kawa SK (2006) Preoperative regional maximal removal rate of technetium-99m-galactosyl human serum albumin (GSA-Rmax) is useful for judging the safety of hepatic resection. Surgery 140(3):379–386 - PubMed
11. Utsunomiya T, Shimada M, Hanaoka J, Kanamoto M, Ikemoto T, Morine Y et al (2012) Possible utility of MRI using Gd-EOB-DTPA for estimating liver functional reserve. J Gastroenterol 47(4):470–476 - PubMed
12. Thomas MN, Weninger E, Angele M, Bosch F, Pratschke S, Andrassy J et al (2015) Intraoperative simulation of remnant liver function during anatomic liver resection with indocyanine green clearance (LiMON) measurements. HPB Off J Int HepatoPancreato Biliary Assoc 17(6):471–476 - PubMed
13. Okochi O, Kaneko T, Sugimoto H, Inoue S, Takeda S, Nakao A (2002) ICG pulse spectrophotometry for perioperative liver function in hepatectomy. J Surg Res 103(1):109–113 - PubMed
14. Haegele S, Reiter S, Wanek D, Offensperger F, Pereyra D, Stremitzer S et al (2016) Perioperative non-invasive indocyanine green-clearance testing to predict postoperative outcome after liver resection. PLoS ONE 11(11):e0165481 - PubMed
15. Yokoyama Y, Nishio H, Ebata T, Igami T, Sugawara G, Nagino M (2010) Value of indocyanine green clearance of the future liver remnant in predicting outcome after resection for biliary cancer. Br J Surg 97(8):1260–1268 - PubMed
16. Rahbari NN, Garden OJ, Padbury R, Brooke-Smith M, Crawford M, Adam R et al (2011) Posthepatectomy liver failure: a definition and grading by the International Study Group of Liver Surgery (ISGLS). Surgery 149(5):713–724 - PubMed
17. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD et al (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250(2):187–196 - PubMed
18. Perkins NJ, Schisterman EF (2006) The inconsistency of “optimal” cutpoints obtained using two criteria based on the receiver operating characteristic curve. Am J Epidemiol 163(7):670–675 - PubMed
19. Sumiyoshi T, Shima Y, Okabayashi T, Kozuki A, Hata Y, Noda Y et al (2016) Liver function assessment using 99mTc-GSA single-photon emission computed tomography (SPECT)/CT fusion imaging in hilar bile duct cancer: A retrospective study. Surgery 160(1):118–126 - PubMed
20. Sumiyoshi T, Shima Y, Okabayashi T, Noda Y, Hata Y, Murata Y et al (2014) Functional discrepancy between two liver lobes after hemilobe biliary drainage in patients with jaundice and bile duct cancer: an appraisal using (99m)Tc-GSA SPECT/CT fusion imaging. Radiology 273(2):444–451 - PubMed
21. Ohwada S, Kawate S, Hamada K, Yamada T, Sunose Y, Tsutsumi H et al (2006) Perioperative real-time monitoring of indocyanine green clearance by pulse spectrophotometry predicts remnant liver functional reserve in resection of hepatocellular carcinoma. Br J Surg 93(3):339–346 - PubMed
22. Tanoue Y, Nanashima A, Yano K, Fujii Y, Hiyoshi M, Imamura N et al (2019) Significance of the preoperative regional maximal removal rate of technetium-99m-galactosyl human serum albumin in the future remnant liver: a sequential study of regional maximal removal rate of technetium-99m-galactosyl human serum albumin in the whole liver. Nucl Med Commun 40(2):145–152 - PubMed
23. Yamada S, Shimada M, Morine Y, Imura S, Ikemoto T, Saito Y et al (2019) A new formula to calculate the resection limit in hepatectomy based on Gd-EOB-DTPA-enhanced magnetic resonance imaging. PLoS ONE 14(1):e0210579 - PubMed

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