title: Two-staged procedure of portal ligation and hepatectomy monitored by ICG clearance.
abstract: BACKGROUND
  The aim of the study was to predict and estimate the optimal time of resection following portal vein ligation (PVL) with the aid of three dimensional (3D) computed tomography (CT) volumetry and indocyanine green (ICG) clearance in healthy liver. Following right PVL, we induced hypertrophy of the left liver lobe prior to an extended right hepatectomy.
  
  
  METHODS
  Fourteen patients with right lobe liver metastases from colorectal cancer underwent right PVL. Cutoff points for the ICG clearance test were: R15 < 14% or PDR > 15%/min. The criteria for resection also required a remnant liver volume of 25% of the whole liver volume. The latter was assessed by CT scan prior to the procedures. Liver function was measured with routine biochemical tests and ICG clearance. Postoperatively, repeated ICG clearance and 3D CT volumetry tests were used to estimate the liver's regeneration. Liver resections were performed as a second stage.
  
  
  RESULTS
  After portal ligation, ICG clearance increased significantly in some patients, while in others, the ICG clearance remained unchanged with borderline low or normal clearance values. Between the two operations, patients with high clearance had less complications and a better regeneration rate of the left lobe with a shorter waiting period in contrast to the "low ICG group."
  
  
  CONCLUSIONS
  ICG clearance has a significant prognostic value. Patients with an apparently inoperable right lobe liver tumor can be successfully treated using a two-staged procedure of portal vain ligation followed by hepatectomy. The 3D CT volumetry and ICG clearance test are essential monitoring tools in these liver resections.
authors.affiliation: 1st Department of Surgery, Semmelweis University, Budapest, Hungary. szijartoattila@gmail.com
authors.forename: Attila
authors.initials: A
authors.lastname: Szijártó
authors.forename: Bálint
authors.initials: B
authors.lastname: Hargitai
authors.forename: Simon
authors.initials: S
authors.lastname: Fischer
authors.forename: Katalin
authors.initials: K
authors.lastname: Darvas
authors.forename: Péter
authors.initials: P
authors.lastname: Kupcsulik
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000473:pathology; D054893:Cone-Beam Computed Tomography; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D007208:Indocyanine Green; D007430:Intraoperative Care / Q000379:methods*; D008026:Ligation; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000601:surgery*; D013997:Time Factors
chemical_list: D007208:Indocyanine Green