Intraoperative ICG test predicts postoperative complications in patients undergoing a staged hepatic resection

Abstract

Introduction: Sufficient function of the future liver remnant is requisite to avoid post-hepatectomy liver failure (PHLF). Different diagnostic tools help to estimate the volume and function. However, a tool to evaluate reliably the functional capacity of future liver remnant (FLR) is missing. Methods: Between September 2015 and May 2017, all consecutive patients undergoing staged hepatectomies received MRI or CT-scans to assess sFLR; 99mTc-Iodida scan was performed to assess the functional capacity. Pre- and intraoperative Indocyaningreen tests (ICGTest) were performed to compare the different tests and with the outcome. Postoperative complications were graded and calculated according to Clavien-Dindo and Comprehensive Complication Index (CCI). Results: 15 patients were included, median age 57. 9 patients hat major complications (≥ grade III); median CCI was 22.6. One patient died postoperatively. Median preoperative R15 was 5 [IQR 2.2 - 8.8]. No significant correlation was found between sFLR, 99mTc-Iodida scan and R15. Preoperative R15, 99mTc-Iodida scan and sFLR did not correlate to CCI. Intraoperative R15 was median 11.4 [IQR 5.3 - 17]; it correlated to end-of hospitalization CCI (p=0.05) and to 90 day CCI (p=0.0036). ROC curve analysis revealed that a cutoff value of 11.4 for intraoperative R15 was able to identify postoperative major complications. Discussion: Intraoperative ICGtesting allows real-time monitoring of the functional capacity of future remnant liver by clamping of arterial and porto-venous inflow of the part to be resected. We herewith propose a cutoff of intraoperative ICG that will be validated in a larger cohort. It could help to prevent disastrous postoperative consequences.