Abstract

BackgroundPostoperative liver dysfunction may lead to morbidity and mortality after liver resection. Preoperative liver function assessment is critical to identify preexisting liver dysfunction in patients prior to resection. The aim of this study was to evaluate the predictive potential of perioperative indocyanine green (ICG)-clearance testing to prevent postoperative liver dysfunction and morbidity using standardized outcome parameters in a routine Western-clinical-setting.Study Design137 patients undergoing partial hepatectomy between 2011 and 2013, at the general hospital of Vienna, were included. ICG-clearance was recorded one day prior to surgery as well as on the first and fifth postoperative day. Postoperative liver dysfunction was defined according to the International Study Group of Liver Surgery and evaluation of morbidity was based on the Dindo-Clavien classification. Statistical analyses were based on non-parametric tests.ResultsPreoperative reduced ICG—plasma disappearance rate (PDR) as well as increased ICG—retention rate at 15 min (R15) were able to significantly predict postoperative liver dysfunction (Area under the curve = PDR: 0.716, P = 0.018; R15: 0.719, P = 0.016). Furthermore, PDR <17%/min. or R15 >8%, were able to accurately predict postoperative complications prior to surgery. In addition to this, ICG-clearance on postoperative day 1 comparably predicted postoperative liver dysfunction (Area under the curve = PDR: 0.895; R15: 0.893; both P <0.001), specifically, PDR <10%/min or R15 >20% on postoperative day 1 predicted poor postoperative outcome.ConclusionPDR and R15 may represent useful parameters to distinguish preoperative high and low risk patients in a Western collective as well as on postoperative day 1, to identify patients who require closer monitoring for potential complications.

Highlights

  • Substantial technical and anesthesiological advances in the field of liver surgery allow performing extended resections in borderline resectable patients [1]

  • Indocyanine green (ICG)–clearance test has been shown to correlate with liver function and has recently been found to predict portal hypertension [10,11,12]

  • Since the ICG-clearance test quantitatively reflects the parenchymal function as well as flow conditions of the liver [12, 20], the perioperative time course of ICG-clearance was initially characterized in patients undergoing liver resection (Fig 1A/1B)

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Summary

Introduction

Substantial technical and anesthesiological advances in the field of liver surgery allow performing extended resections in borderline resectable patients [1]. Numerous methods have been developed to accurately predict poor postoperative hepatic recovery and to determine the maximum amount of liver tissue that can be resected during liver surgery. While volumetry is frequently used to determine future liver remnant, functional assessment of the liver parenchyma is of crucial importance to identify patients that will need an extended amount of remnant liver tissue to sustain postoperative liver function. Indocyanine green (ICG)–clearance test has been shown to correlate with liver function and has recently been found to predict portal hypertension [10,11,12]. The aim of this study was to evaluate the predictive potential of perioperative indocyanine green (ICG)-clearance testing to prevent postoperative liver dysfunction and morbidity using standardized outcome parameters in a routine Western-clinical-setting

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