title: Volumetric analysis and indocyanine green retention rate at 15 min as predictors of post-hepatectomy liver failure.
abstract: OBJECTIVE
  The actual future liver remnant (aFLR) is calculated as the ratio of remnant liver volume (RLV) to total functional liver volume (TFLV). The standardized future liver remnant (sFLR) is calculated as the ratio of RLV to standard liver volume (SLV). The aims of this study were to compare the aFLR with the sFLR and to determine criteria for safe hepatectomy using computed tomography volumetry and indocyanine green retention rate at 15 min (ICG R15).
  
  
  METHODS
  Medical records and volumetric measurements were obtained retrospectively for 81 patients who underwent right hemi-hepatectomy for malignant hepatic tumours from January 2010 to November 2013. The sFLR was compared with the aFLR, and a ratio of sFLR to ICG R15 as a predictor of postoperative hepatic function was established.
  
  
  RESULTS
  In patients without cirrhosis, the sFLR showed a stronger correlation with the total serum bilirubin level than the aFLR (R(2) = 0.499 versus R(2) = 0.239). Post-hepatectomy liver failure developed only in the group with an sFLR of <25%, regardless of ICG R15. In patients with cirrhosis, the aFLR and sFLR had no correlation with postoperative total serum bilirubin. An sFLR : ICG R15 ratio of >1.9 showed 66.7% sensitivity and 100% specificity.
  
  
  CONCLUSIONS
  Regardless of ICG R15, an sFLR of ≥ 25% in patients without cirrhosis, and an sFLR of ≥ 25% with an sFLR : ICG R15 ratio of >1.9 in patients with cirrhosis indicate acceptable levels of safety in major hepatectomy.
authors: Department of Surgery, Chonnam National University Medical School, Gwangju, South Korea.
authors: Hee Joon
authors: HJ
authors: Kim
authors: Choong Young
authors: CY
authors: Kim
authors: Eun Kyu
authors: EK
authors: Park
authors: Young Hoe
authors: YH
authors: Hur
authors: Yang Seok
authors: YS
authors: Koh
authors: Hyun Jong
authors: HJ
authors: Kim
authors: Chol Kyoon
authors: CK
authors: Cho
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000601:surgery; D001653:Bile Ducts, Intrahepatic; D006528:Carcinoma, Hepatocellular / Q000601:surgery; D018281:Cholangiocarcinoma / Q000601:surgery; D005260:Female; D006498:Hepatectomy; D006801:Humans; D007208:Indocyanine Green / Q000378:metabolism; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis; D017093:Liver Failure / Q000175:diagnosis; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery; D008297:Male; D009929:Organ Size; D014057:Tomography, X-Ray Computed
chemical_list: D007208:Indocyanine Green