Right Hepatectomy for Hepatocellular Carcinoma in Patients with an Indocyanine Green Retention Rate at 15 Minutes of 10% or Higher

Abstract

Background/Aims: Liver failure after right hepatectomy for hepatocellular carcinoma (HCC) in patients with an indocyanine green retention rate at 15 min (ICGR₁₅) of 10% or higher remains a controversial issue. Methods: Between 1995 and 2004, 98 patients with an ICGR₁₅ of 10% or higher were scheduled to undergo right hepatectomy or tri-sectionectomy for HCC. The hepatic resection volume (HR) excluding the tumor was measured using computed tomography. The allowable HR (AHR) was determined in each patient with a logarithmic graph based on the ICGR₁₅ and the %HR. Liver failure and mortality were evaluated between 54 patients with HR ≤ AHR (low-risk group) and 44 patients with HR > AHR (high-risk group). Results: The number of patients with liver failure was significantly lower in the low-risk group (2%) than in the high-risk group (23%, p = 0.0021). No mortality was observed in the low-risk group, while mortality was seen in the high-risk group (11%, p = 0.016). Multivariate analysis showed that the high-risk group was identified as a significant predictor of liver failure (p = 0.011). Conclusions: In patients with an ICGR₁₅ of 10% or higher, determination of AHR is useful to predict liver failure prior to right hepatectomy or tri-sectionectomy.