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Quantified Risk Assessment for Major Hepatectomy via the Indocyanine Green Clearance Rate and Liver Volumetry Combined with Standard Liver Volume

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Preoperative risk assessment for post-hepatectomy liver failure (PHLF) is essential for major hepatectomy. We intended to establish a standard liver volume (SLV) formula for Korean patients and validate the predictive power of the indocyanine green clearance rate constant (ICG-K) fraction of future remnant liver (FRL) (FRL-kICG) to total liver volume (TLV).

Methods

This study comprised 2 retrospective studies. Part I established SLV formula and acquired ICG pharmacokinetic data from 2155 living donors. In part II, FRL-kICG cutoff was determined using 723 patients who underwent right liver resection for hepatocellular carcinoma.

Results

In part I, the formula SLV (mL) = −456.3 + 969.8 × BSA (m2) (r = 0.707, r 2 = 0.500, p = 0.000) was derived with mean volume error of 10.5 %. There was no correlation between TLV and ICG retention rate at 15 min. With a cutoff of 0.04 with hepatic parenchymal resection rate (PHRR) limit of 70 %, 99.0 % of our living donors were permissible for left or right hepatectomy. In part II, 25 hepatocellular carcinoma patients (3.5 %) showed an FRL-kICG or SLV-corrected FRL-kICG <0.05. Of these, 4 (16 %) died of PHLF, whereas only 2 (0.3 %) died in the other patient group with both an FRL-kICG and SLV-corrected FRL-kICG ≥ 0.05 (P = 0.000).

Conclusions

The FRL-kICG appears to reliably predict PHLF risk quantitatively. We suggest FRL-kICG cutoffs of 0.04 and 0.05 with PHRR limits of 70 % and 65 % for normal and diseased livers, respectively. Further validation with large patient population in multicenter studies is necessary to improve FRL-kICG predictability.

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Abbreviations

BMI:

Body mass index

BSA:

Body surface area

ICG:

Indocyanine green

ICG-R15 :

ICG retention rate at 15 min

ICG-K:

ICG clearance rate constant

ICG-Rmax :

Maximum removal rate of ICG

SLV:

Standard liver volume

TLV:

Total liver volume

PHRR:

Parenchymal hepatic resection rate

FRL:

Future remnant liver

FRL-kICG:

ICG-K fraction of FRL

LDLT:

Living donor liver transplantation

HCC:

Hepatocellular carcinoma

PHLF:

Post-hepatectomy liver failure

CT:

Computed tomography

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Conflict of Interest

None of the authors has any conflict of interest.

Source of Funding

None of the authors was supported financially for this study.

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Authors and Affiliations

  1. Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Poongnap-dong, Songpa-gu, Seoul, 138-736, South Korea

    Shin Hwang, Tae-Yong Ha, Gi-Won Song, Dong-Hwan Jung, Chul-Soo Ahn, Deok-Bog Moon, Ki-Hun Kim, Young-Joo Lee & Sung-Gyu Lee

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  1. Shin Hwang
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  2. Tae-Yong Ha
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Correspondence to Shin Hwang.

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Hwang, S., Ha, TY., Song, GW. et al. Quantified Risk Assessment for Major Hepatectomy via the Indocyanine Green Clearance Rate and Liver Volumetry Combined with Standard Liver Volume. J Gastrointest Surg 19, 1305–1314 (2015). https://doi.org/10.1007/s11605-015-2846-8

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  • DOI: https://doi.org/10.1007/s11605-015-2846-8

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