Predictive Value of Intraoperative Indocyanine Green Clearance Measurement on Postoperative Liver Function After Anatomic Major Liver Resection

Abstract

Background

The aim of this study was to evaluate the predictive value of measuring indocyanine green (ICG) clearance during intraoperative partial occlusion of liver lobes to be resected on postoperative liver function following major anatomic liver resection.

Methods

We prospectively included 46 patients, and 35 patients ultimately underwent anatomic major liver resection. ICG clearance was measured preoperatively and intraoperatively. Intraoperative ICG clearance was measured immediately after selective occlusion of hepatic arterial, portal, and hepatic venous blood flow to the liver lobes to be resected. The albumin-bilirubin (ALBI) grade, albumin-indocyanine green evaluation (ALICE) grade, platelet count, remnant liver volume per kilogram of weight (RLV/kg), and future liver remnant plasma clearance rate of ICG (ICGK-FLR) were measured preoperatively.

Results

An intraoperative ICG retention at 15 min (I-R15) greater than 13.8% indicates transient posthepatectomy liver failure (PHLF) and Clavien-Dindo > grade I complications. Receiver operating characteristic (ROC) curve analysis revealed that the area under the curve (AUC) for predicting PHLF and Clavien-Dindo > grade I complications was 0.797 and 0.734, respectively (p = 0.001 and 0.014). Furthermore, an I-R15 greater than 22.7% indicates mid-term PHLF, and the AUC was 0.911 (p < 0.0001). The I-R15 is a better predictor of PHLF than the ALBI grade, ALICE grade, platelet count, RLV/kg, and ICGK-FLR.

Conclusions

Intraoperative ICG clearance measurements during partial occlusion of blood flow accurately predict postoperative liver function and could be new criteria for determining the feasibility and safety of anatomic major liver resection.

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Financial Support

This work was jointly supported by Wu Jieping Medical Foundation (320.2710.1857), National Natural Science Foundation of China (81874182, 81874056), National Key Project of China (2017ZX10203204-007-004), Public Health Bureau Foundation of Shanghai (201840019), and Research Talent Foundation of Fudan University Shanghai Cancer Center (YJRC1604).

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Contributions

Longrong Wang, Li Xie, and Ning Zhang contributed equally to this study. All authors had access to the study data and had reviewed and approved the final manuscript.

Corresponding authors

Correspondence to Lu Wang or Yiming Zhao.

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Conflict of Interest

Longrong Wang Activities related to the present article: disclosed no relevant relationship. Activities not related to the present article: author received grants from Wu Jieping Medical Foundation, China. Other relationships: none to disclose. Weiping Zhu Activities related to the present article: disclosed no relevant relationship. Activities not related to the present article: author received grants from National Natural Science Foundation of China and Public Health Bureau Foundation of Shanghai, China. Other relationships: none to disclose. Lu Wang Activities related to the present article: disclosed no relevant relationship. Activities not related to the present article: author received grants from National Natural Science Foundation of China, National Key Project of China and Research Talent Foundation of Fudan University Shanghai Cancer Center, China. Other relationships: none to disclose. Yiming Zhao, Li Xie, Ning Zhang, Jiamin Zhou, Qi Pan, Anrong Mao and Zhenhai Lin Activities to the present article: none to disclose. Activities not related to the present article: none to disclose. Other relationships: none to disclose.

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Wang, L., Xie, L., Zhang, N. et al. Predictive Value of Intraoperative Indocyanine Green Clearance Measurement on Postoperative Liver Function After Anatomic Major Liver Resection. J Gastrointest Surg 24, 1342–1351 (2020). https://doi.org/10.1007/s11605-019-04262-5

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Keywords

  • Intraoperative indocyanine green clearance measurement
  • Anatomic major liver resection
  • Partial occlusion of blood flow
  • Posthepatectomy liver failure
  • Clavien-Dindo grade