Keiichi Kubota1, Taku Aoki1, Hiraku Kumamaru2, Takayuki Shiraki1, Hiroaki Miyata3, Yasuyuki Seto4, Yoshihiro Kakeji5, Masakazu Yamamoto6. 1. Second Department of Surgery, Dokkyo Medical University, Tochigi, Japan. 2. Department of Healthcare Quality Assessment, The University of Tokyo, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan. 3. Department of Health Policy and Management, School of Medicine, Keio University, Tokyo, Japan. 4. The Japanese Society of Gastroenterological Surgery, Tokyo, Japan. 5. Database Committee, The Japanese Society of Gastroenterological Surgery, Tokyo, Japan. 6. The Japanese Society of Hepato-Biliary-Pancreatic Surgery, Tokyo, Japan.
Abstract
BACKGROUND: The aim of the present study was to clarify the association between preoperative liver function and complications after hepatectomy. METHODS: The study included 11,686 patients registered in the National Clinical Database for 2015 for whom data on indocyanine green at 15 min (ICG15) and hepatectomy were available. The patients were divided into four groups: group A (ICG15 <10%; n = 5,661), group B (ICG15 10% to <20%; n = 4,381), group C (ICG15 20% to <30%; n = 1,173) and group D (ICG15 >30%; n = 463). Hepatectomy procedures were classified as partial resection (n = 3,934), systematic subsegmentectomy (n = 2,055), monosectionectomy (n = 2,043), bisectionectomy (n = 2,993) and trisectionectomy (n = 208). Complications were classified using the Clavien-Dindo classification (CD) and evaluated by ICG15 category and procedure type. RESULTS: Complications more severe than CD III increased significantly as the operation time lengthened and the intraoperative bleeding volume increased (P < 0.001). ICG15 category was positively associated with operative death, >CD III complications, surgical site infection (SSI), liver failure, and intractable ascites for many of the major hepatectomy procedures, but not with bile leakage. More complications were observed in patients outside the Makuuchi criteria than in those within the criteria. CONCLUSIONS: Operation time and intraoperative bleeding volume are significantly associated with severe postoperative complications in patients undergoing hepatectomy. ICG15 is a good indicator predictive of operative death, >CD III complications, SSI, liver failure and intractable ascites.
BACKGROUND: The aim of the present study was to clarify the association between preoperative liver function and complications after hepatectomy. METHODS: The study included 11,686 patients registered in the National Clinical Database for 2015 for whom data on indocyanine green at 15 min (ICG15) and hepatectomy were available. The patients were divided into four groups: group A (ICG15 <10%; n = 5,661), group B (ICG15 10% to <20%; n = 4,381), group C (ICG15 20% to <30%; n = 1,173) and group D (ICG15 >30%; n = 463). Hepatectomy procedures were classified as partial resection (n = 3,934), systematic subsegmentectomy (n = 2,055), monosectionectomy (n = 2,043), bisectionectomy (n = 2,993) and trisectionectomy (n = 208). Complications were classified using the Clavien-Dindo classification (CD) and evaluated by ICG15 category and procedure type. RESULTS: Complications more severe than CD III increased significantly as the operation time lengthened and the intraoperative bleeding volume increased (P < 0.001). ICG15 category was positively associated with operative death, >CD III complications, surgical site infection (SSI), liver failure, and intractable ascites for many of the major hepatectomy procedures, but not with bile leakage. More complications were observed in patients outside the Makuuchi criteria than in those within the criteria. CONCLUSIONS: Operation time and intraoperative bleeding volume are significantly associated with severe postoperative complications in patients undergoing hepatectomy. ICG15 is a good indicator predictive of operative death, >CD III complications, SSI, liver failure and intractable ascites.
Authors: Elise Kang; John Inho Shin; Adam D Griesemer; Steven Lobritto; Dana Goldner; Jennifer M Vittorio; Steven Stylianos; Mercedes Martinez Journal: J Gastrointest Surg Date: 2021-04-06 Impact factor: 3.452