[Estimation of hepatic resection volume in hepatocellular carcinoma by ICG(R15) and its relation with postoperative liver failure].
OBJECTIVE
It is important to accurately estimate liver reserve function before hepatectomy for hepatocellular carcinoma (HCC), and to determine proper hepatic resection volume during operation, thus, to avoid postoperative liver failure. Recently, indocyanine green retention rate at 15 min (ICG(R15)) has been considered as a sensitive marker for liver reserve function. However, how to evaluate the maximal hepatic resection volume according to liver reserve function, especially ICG(R15), remains controversial. This study was to evaluate the influence of ICG(R15) and hepatic resection volume on postoperative liver failure.


METHODS
Records of 225 HCC patients who underwent hepatectomy were retrospectively reviewed. Preoperative ICG(R15) value, intraoperative hepatic resection volume, and postoperative liver function were analyzed.


RESULTS
Of the 225 patients, 113 received resection of no more than 1 segment (group A), 76 received resection of 1-2 segments (group B), 36 received resection of more than 2 segments (group C). When ICG(R15) was below 10%, the incidences of postoperative ascites in groups A, B, and C were 21.2% (14/66), 14.3% (8/56), and 15.4% (4/26), respectively (P>0.05); the incidences of jaundice were 3.0% (2/66), 7.1% (4/56), and 15.4% (4/26), respectively (P>0.05). When ICG(R15) was 10%-20%, the incidences of ascites were 26.8% (11/41), 38.9%(7/18), and 50.0% (5/10), respectively (P>0.05); the incidence of jaundice was lower in group A than in group B, and group C [0 (0/41) vs. 27.8% (5/18), and 20.0% (2/10), P<0.01]; 2 patients, who had 2 or 3 segments resected, died of postoperative encephalopathy. When ICG(R15) was more than 20%, ascites occurred in 2 of 6 patients (33.3%) in group Au both of the 2 cases in group B developed postoperative ascites and jaundice, and 1 died.


CONCLUSIONS
When ICG(R15) is below 10%, 2 or more segments can be resected safely when ICG(R15) is 10%-20%, 1 segment can be resected safely, 2 or more segments may be resected with great care when ICG(R15) is more than 20%, the patient's general condition and other liver function tests should be taken into consideration if 1 segment is resected, resection of 2 or more segments will cause high surgical risk.
Lao
Xiang-Ming
XM
Department of Hepatobiliary, Cancer Center, Sun Yat-sen University, Guangzhou, Guangdong, 510060, P.R.China. sumslxm@21cn.com.
Zhang
Ya-Qi
YQ
Lin
Xiao-Jun
XJ
Guo
Rong-Ping
RP
Chen
Min-Shan
MS
Yuan
Yun-Fei
YF
Li
Jin-Qing
JQ
Li
Guo-Hui
GH
D000293:Adolescent; D000328:Adult; D000368:Aged; D001201:Ascites / Q000209:etiology; D006528:Carcinoma, Hepatocellular / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects* / Q000379:methods; D006501:Hepatic Encephalopathy / Q000209:etiology; D006801:Humans; D007208:Indocyanine Green; D007565:Jaundice / Q000209:etiology; D017093:Liver Failure / Q000209:etiology; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
D007208:Indocyanine Green