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

• DOI: 10.1007/s00268-021-06289-9
• Publication Date: 2021-08-14T21:02:26Z
• Authors: Naoya Sato; Akira Kenjo; Seiko Suzushino; Takashi Kimura; Ryo Okada; Teruhide Ishigame; Yasuhide Kofunato; Shigeru Marubashi
• Keywords: Indocyanine Green; Carcinoma, Hepatocellular; Liver Neoplasms; 03 medical and health sciences; 0302 clinical medicine; Liver; Liver Function Tests; Hepatectomy; Humans; Prospective Studies; Liver Failure; Retrospective Studies

AbstractBackgroundPrediction 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.MethodsThis 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.ResultsOf 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).ConclusionsIntraoperative ICG clearance in the remnant liver was a promising predictor for PHLF in patients undergoing anatomical hepatectomy, especially in patients with BD.