Abstract
Background. Hepatectomy, an important treatment modality for liver malignancies, has high perioperative morbidity and mortality rates. Safe, comprehensive criteria for selecting patients for hepatectomy are needed. Since June 2011, we have used a cut-off value of ≧ 0.05 for future liver remnant plasma clearance rate of indocyanine green as a criterion for hepatectomy. The aim of this study was to verify the validity of this criterion. Methods. From June 2011 to December 2015, 212 hepatectomies were performed in Tenri Yorozu Hospital. Of these 212 patients, 107 who underwent preoperative computed tomography imaging volumetry, indocyanine green clearance test, and hepatectomy (excluding partial resection or enucleation) were retrospectively analyzed. Results. There was no postoperative mortality. Posthepatectomy liver failure occurred in 59 patients (55.1%) (International Study Group of Liver Surgery Grade A: 43 cases (40.2%), Grade B: 16 cases (15.0%), and Grade C: no cases). Operative morbidity greater than Clavien-Dindo Grade 3 occurred in 23 patients (21.5%). A low future liver remnant plasma clearance rate of indocyanine green was a good predictor for Grade B cases (area under curve = 0.804; 95% confidence interval, 0.712–0.895). Conclusion. Liver remnant plasma clearance rate of indocyanine green is a valid criterion for hepatectomy.
Highlights
Hepatectomy is an important treatment modality for liver malignancies
In 1980, Takasaki et al reported that future liver remnant plasma clearance rate of indocyanine green (ICG) was useful for predicting posthepatectomy liver function [2]
There was one inhospital death that was not directly related to hepatectomy
Summary
Hepatectomy is an important treatment modality for liver malignancies. On the other hand, postoperative morbidity and mortality rates are still high. In 1993, Makuuchi’s criteria [1] were proposed for hepatectomy in patients with underlying liver diseases These criteria are based on presence or absence of ascites, preoperative total bilirubin concentration, and indocyanine green (ICG) retention rate at 15 minutes and have since been widely accepted in Japan. In 1980, Takasaki et al reported that future liver remnant plasma clearance rate of ICG (rICGK) was useful for predicting posthepatectomy liver function [2]. Hepatectomy, an important treatment modality for liver malignancies, has high perioperative morbidity and mortality rates. Since June 2011, we have used a cut-off value of ≧ 0.05 for future liver remnant plasma clearance rate of indocyanine green as a criterion for hepatectomy. Liver remnant plasma clearance rate of indocyanine green is a valid criterion for hepatectomy
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