title: Quantified Risk Assessment for Major Hepatectomy via the Indocyanine Green Clearance Rate and Liver Volumetry Combined with Standard Liver Volume.
abstract: BACKGROUND
  Preoperative risk assessment for post-hepatectomy liver failure (PHLF) is essential for major hepatectomy. We intended to establish a standard liver volume (SLV) formula for Korean patients and validate the predictive power of the indocyanine green clearance rate constant (ICG-K) fraction of future remnant liver (FRL) (FRL-kICG) to total liver volume (TLV).
  
  
  METHODS
  This study comprised 2 retrospective studies. Part I established SLV formula and acquired ICG pharmacokinetic data from 2155 living donors. In part II, FRL-kICG cutoff was determined using 723 patients who underwent right liver resection for hepatocellular carcinoma.
  
  
  RESULTS
  In part I, the formula SLV (mL) = -456.3 + 969.8 × BSA (m(2)) (r = 0.707, r (2) = 0.500, p = 0.000) was derived with mean volume error of 10.5%. There was no correlation between TLV and ICG retention rate at 15 min. With a cutoff of 0.04 with hepatic parenchymal resection rate (PHRR) limit of 70%, 99.0% of our living donors were permissible for left or right hepatectomy. In part II, 25 hepatocellular carcinoma patients (3.5%) showed an FRL-kICG or SLV-corrected FRL-kICG <0.05. Of these, 4 (16 %) died of PHLF, whereas only 2 (0.3%) died in the other patient group with both an FRL-kICG and SLV-corrected FRL-kICG ≥ 0.05 (P = 0.000).
  
  
  CONCLUSIONS
  The FRL-kICG appears to reliably predict PHLF risk quantitatively. We suggest FRL-kICG cutoffs of 0.04 and 0.05 with PHRR limits of 70% and 65% for normal and diseased livers, respectively. Further validation with large patient population in multicenter studies is necessary to improve FRL-kICG predictability.
authors.affiliation: Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Poongnap-dong, Songpa-gu, Seoul, 138-736, South Korea, shwang@amc.seoul.kr.
authors.forename: Shin
authors.initials: S
authors.lastname: Hwang
authors.forename: Tae-Yong
authors.initials: TY
authors.lastname: Ha
authors.forename: Gi-Won
authors.initials: GW
authors.lastname: Song
authors.forename: Dong-Hwan
authors.initials: DH
authors.lastname: Jung
authors.forename: Chul-Soo
authors.initials: CS
authors.lastname: Ahn
authors.forename: Deok-Bog
authors.initials: DB
authors.lastname: Moon
authors.forename: Ki-Hun
authors.initials: KH
authors.lastname: Kim
authors.forename: Young-Joo
authors.initials: YJ
authors.lastname: Lee
authors.forename: Sung-Gyu
authors.initials: SG
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D000328:Adult; D001830:Body Surface Area; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D004396:Coloring Agents / Q000493:pharmacokinetics; D046148:Donor Selection; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects*; D006801:Humans; D007208:Indocyanine Green / Q000493:pharmacokinetics; D008099:Liver / Q000473:pathology* / Q000503:physiopathology; D017093:Liver Failure / Q000209:etiology* / Q000503:physiopathology; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D055815:Young Adult
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green