Value of indocyanine green clearance of the future liver remnant in predicting outcome after resection for biliary cancer.
BACKGROUND
It is difficult to predict hepatic functional reserve accurately before major hepatectomy. The aim of this study was to analyse the usefulness of the future liver remnant plasma clearance rate of indocyanine green (ICGK-F, calculated as plasma clearance rate of indocyanine green (ICGK) x proportion of the future liver remnant) in predicting death after major hepatectomy.


METHODS
Data on ICGK and ICGK-F were collected prospectively and analysed retrospectively for 274 patients who underwent right hepatectomy, right trisectionectomy or left trisectionectomy for biliary cancer between 1991 and 2008. The mortality rate and incidence of postoperative complications were analysed. Patients were separated into two groups according to year of operation (85 patients operated on between 1991 and 2000; 189 from 2001 to 2008).


RESULTS
In multiple logistic regression analyses, an ICGK-F less than 0.05 had the strongest impact on the incidence of postoperative mortality (odds ratio 8.06; P < 0.001). The postoperative mortality rate was significantly lower in the later period (P < 0.001). In patients with an ICGK-F value between 0.040 and 0.049, the mortality rate in the early period was 30 per cent, whereas it was only 8 per cent in the later period.


CONCLUSIONS
An ICGK-F of 0.05 is a useful cut-off value for predicting mortality and morbidity. With careful perioperative patient management in an experienced institution, this cut-off value can be lowered further.
Yokoyama
Y
Y
Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
Nishio
H
H
Ebata
T
T
Igami
T
T
Sugawara
G
G
Nagino
M
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001661:Biliary Tract Neoplasms / Q000401:mortality* / Q000503:physiopathology / Q000601:surgery; D004396:Coloring Agents / Q000493:pharmacokinetics; D019299:Decompression, Surgical; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000401:mortality*; D006801:Humans; D007208:Indocyanine Green / Q000493:pharmacokinetics; D041781:Jaundice, Obstructive / Q000209:etiology / Q000401:mortality / Q000601:surgery; D017114:Liver Failure, Acute / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies
D004396:Coloring Agents; D007208:Indocyanine Green