The guidance value of indocyanine green test on small hepatocellular carcinoma operation selection

Abstract

Objective To investigate the guidance value of indocyanine green test on the selection of small hepatocellular carcinoma operation. Methods The clinical data of 143 cases of small hepatocellular carcinoma who underwent indocyanine green test were collected. These patients have accepted liver resection or percutaneous radiofrequency ablation (PRFA). They were divided into liver resection group and RF group. On the basis of the occurrence of liver failure after operation, they were divided into liver failure group and non liver failure group again. There was a total of four groups. The clinical data of the four groups were compared, and the diffences in indocyanine green retention rate of 15 min (ICG-R15) and Child-Pugh (CP) grade were observed. Based on the variances of ICG-R15, the patients in liver resection group were streamed into three subgroups: (1) ICG-R15 30%. Meanwhile, the patients in PRFA group were divided into three subgroups: (1) ICG-R15 40%. Finally, the difference in hepatic failure rate was compared between different groups in the same operation mode. Results The differences were not statistically significant in the clinial data among four groups (P=0.732, P=0.686, P=0.863, P=0.748, P=0.862, P=0.732). However, the difference was statistically significant in ICG-R15 and CP grade (P=0.006, P=0.017, P=0.046, P=0.021). In the liver resection group, the rate of hepatic failure in ICG-R15 30% subgroup was 2.3%, 12.5% and 55.5% respectively. The difference was statistically significant between ICG-R15 30% subgroup (P=0.000). In the PRFA group, the rate of hepatic failure in ICG-R15 40% subgroup was 0, 11.1% and 66.7%. The difference was statistically significant between ICG-R15 40% subgroup (P=0.001). Conclusion The ICG -R15 are sensitive indicators to assess liver reserve function, which has the guiding value on the selection of operation mode of small liver cancer. Liver resection and radiofrequency ablation were all safe when ICG-R15 40%, radiofrequency ablation was not suitable and liver protection therapy was recommended. Decision of surgical plan was made after liver function to be improved. Key words: Small liver resection; Hepatectomy; Radiofrequency catheter ablation; Indocyanine green test; Child-Pugh classification