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Indocyanine Green Retention Rates at 15 min Predicted Hepatic Decompensation in a Western Population

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Abstract

Background

ICGR15 is widely used in Asia to evaluate the liver reserve before hepatectomy, but not in Western countries where patients are selected using the MELD score and/or platelet count. Postoperative liver failure is rare nowadays, but hepatic decompensation (HD), defined by 3-month postoperative ascites, impairs quality of life and survival. The aim of this study was to evaluate the relevance of indocyanine green retention rate at 15 min (ICGR15) before liver resection in Western countries, in order to predict HD.

Methods

This prospectively designed study included consecutive adult patients undergoing hepatectomy for hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC) in three French HPB centres.

Results

Between 2012 and 2014, 147 patients were included (80% of HCC and 20% of ICC). The Child–Pugh status was grade A for all patients. In the overall population and in F3/F4 patients (n = 83), ICGR15 (P = 0.02) and platelet counts (P = 0.02) were predictive of HD under multivariate analysis. Among F3/F4 patients undergoing minor hepatectomy with preoperative ICGR15 > 15%, the rate of HD was 36%. In the overall population, ICGR15 was predictive of HD (P = 0.02) and postoperative ascites (P = 0.03). The ROC curve identified a cut-off point of 15% as being associated with increased HD, with good accuracy for ICGR15 in the study population (AUROC 0.73), mainly before minor hepatectomy (AUROC 0.79).

Conclusions

In patients with HCC and ICC selected using the MELD score and platelet rate, an ICGR15 > 15% is a relevant, non-invasive and clearly accurate method to predict HD specially before minor hepatectomy.

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Authors and Affiliations

  1. Centre Hépato-biliaire, Hôpital Paul Brousse, 12 Avenue Paul Vaillant Couturier, 94800, Villejuif, France

    Bertrand Le Roy, Cyril Cossé, Badr Serji, Nicolas Golse, René Adam, Daniel Cherqui & Eric Vibert

  2. Department of Hepatobiliary Surgery, Hôpital de la Conception, 145 Boulevard Baille, 13005, Marseille, France

    Emilie Grégoire & Yves-Patrice Le Treut

  3. Department of Hepatobiliary Surgery, Hôpital La Croix-Rousse, 103 Grande rue de la Croix-Rousse, 69317, Lyon, France

    Nicolas Golse & Jean-Yves Mabrut

  4. Department of Hepatobiliary Surgery, Hôpital Estaing, CHU Clermont Ferrand, 1 Place Lucie Aubrac, 63000, Clermont Ferrand, France

    Bertrand Le Roy

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  1. Bertrand Le Roy
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Correspondence to Bertrand Le Roy.

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Le Roy, B., Grégoire, E., Cossé, C. et al. Indocyanine Green Retention Rates at 15 min Predicted Hepatic Decompensation in a Western Population. World J Surg 42, 2570–2578 (2018). https://doi.org/10.1007/s00268-018-4464-6

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  • DOI: https://doi.org/10.1007/s00268-018-4464-6

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