Predictive value of preoperative ICGR15 combined with standard remnant liver volume to postoperative liver dysfunction after precise hepatectomy for huge hepatocellular carcinoma

Abstract

Objective To investigate the predictive value of preoperative indocyanine green retention rate at 15 min (ICGR15) combined with standard remnant liver volume (SRLV) to postoperative liver dysfunction after precise hepatectomy for huge hepatocellular carcinoma (HCC). Methods A total of 110 patients with huge HCC undergoing precise hepatectomy at the First Affiliated Hospital of Sun Yat-sen University between May 2009 and May 2013 were enrolled in this prospective study. The informed consents of all patients were obtained and the local ethical committee approval had been received. Among the 110 patients, 92 were males and 18 were females with the age ranging from 26 to 75 years old and the median of 48 years old. The tumor size was from 10.1 to 20.5 cm. ICGR15 of all patients were detected and all underwent thin-slice computer tomography (CT) scan before hepatectomy. The livers, tumors and blood vessels of patients were three-dimensionally reconstructed by using the data of CT scan. The surgery was simulated and SRLV was calculated. All patients underwent precise hepatectomy. According to whether postoperative hepatic dysfunction developed, the patients were divided into two groups, the liver dysfunction group (n=18) and non-liver dysfunction group (n=92). The risk factors of postoperative liver dysfunction were analyzed by univariate analysis. The screened factors ICGR15 combined with SRLV were taken as diagnostic indicators for diagnostic tests to explore the best combination of sensitivity and specificity and regression equation for predicting postoperative liver dysfunction was calculated by logistic regression analysis. Results The incidence of liver dysfunction for patients with HCC after precise hepatectomy was 16.4% (18/110). The occurrence of liver dysfunction was associated with the preoperative ICGR15 and SRLV (Z=2.805, t=4.365; P<0.05). When the preoperative ICGRl5 and SRLV taken as diagnostic indicators, the sensitivity was 0.78 and the specificity was 0.89. Its logistic linear regression equation was SRLV (ml/m2) = 1 104 × ICGR15 + 298.6. The regression equation may directly reflect the relationship between ICGR15 and SRLV and the regression line chart may better predict the occurrence of liver dysfunction after precise hepatectomy. Conclusion Preoperative ICGR15 combined with SRLV may efficiently predict the occurrence of postoperative liver dysfunction after precise hepatectomy for huge HCC. Key words: Carcinoma, hepatocellular; Hepatectomy; Hepatic insufficiency