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.
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 carcinomapatients (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: N Yamanaka; E Okamoto; T Oriyama; J Fujimoto; K Furukawa; E Kawamura; T Tanaka; F Tomoda Journal: Ann Surg Date: 1994-04 Impact factor: 12.969