Right hepatectomy for hepatocellular carcinoma in patients with an indocyanine green retention rate at 15 minutes of 10% or higher.
OBJECTIVE
Liver failure after right hepatectomy for hepatocellular carcinoma (HCC) in patients with an indocyanine green retention rate at 15 min (ICGR(15)) of 10% or higher remains a controversial issue.


METHODS
Between 1995 and 2004, 98 patients with an ICGR(15) of 10% or higher were scheduled to undergo right hepatectomy or tri-sectionectomy for HCC. The hepatic resection volume (HR) excluding the tumor was measured using computed tomography. The allowable HR (AHR) was determined in each patient with a logarithmic graph based on the ICGR(15) and the %HR. Liver failure and mortality were evaluated between 54 patients with HR <or= AHR (low-risk group) and 44 patients with HR > AHR (high-risk group).


RESULTS
The number of patients with liver failure was significantly lower in the low-risk group (2%) than in the high-risk group (23%, p = 0.0021). No mortality was observed in the low-risk group, while mortality was seen in the high-risk group (11%, p = 0.016). Multivariate analysis showed that the high-risk group was identified as a significant predictor of liver failure (p = 0.011).


CONCLUSIONS
In patients with an ICGR(15) of 10% or higher, determination of AHR is useful to predict liver failure prior to right hepatectomy or tri-sectionectomy.
Ariizumi
Shun-ichi
S
Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan. ari@gd6.so-net.ne.jp
Yamamoto
Masakazu
M
Takasaki
Ken
K
D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D004396:Coloring Agents; D005260:Female; D006498:Hepatectomy; D006801:Humans; D007208:Indocyanine Green; D017093:Liver Failure / Q000175:diagnosis*; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D014057:Tomography, X-Ray Computed
D004396:Coloring Agents; D007208:Indocyanine Green