1. Indocyanine green clearance of remnant liver (ICG-Krem) predicts postoperative subclinical hepatic insufficiency after resection of colorectal liver metastasis: theoretical validation for safe expansion of Makuuchi's criteria
- Author
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Junichi Shindoh, Yuta Kobayashi, Yoshitaka Kiya, Masaji Hashimoto, and Yujiro Nishioka
- Subjects
Adult ,Indocyanine Green ,Male ,medicine.medical_specialty ,genetic structures ,Bilirubin ,Gastroenterology ,Metastasis ,Resection ,03 medical and health sciences ,chemistry.chemical_compound ,Postoperative Complications ,0302 clinical medicine ,Liver Function Tests ,Predictive Value of Tests ,Internal medicine ,Intensive care ,medicine ,Hepatectomy ,Hepatic Insufficiency ,Humans ,Coloring Agents ,Aged ,Retrospective Studies ,Subclinical infection ,Aged, 80 and over ,Hepatology ,business.industry ,Incidence (epidemiology) ,Liver Neoplasms ,Metastasectomy ,Area under the curve ,Middle Aged ,medicine.disease ,eye diseases ,body regions ,ROC Curve ,chemistry ,030220 oncology & carcinogenesis ,Female ,030211 gastroenterology & hepatology ,Colorectal Neoplasms ,business ,Indocyanine green - Abstract
Multidisciplinary treatment for colorectal liver metastases (CLMs) often includes major hepatectomy for preoperative chemotherapy-related hepatic injury, although the safety limit for resection extent is unclear. We investigated this parameter using the estimated indocyanine green clearance rate (ICG-K) of liver remnants, focusing on postoperative subclinical hepatic insufficiency (PHI).Altogether, 225 patients who underwent resection of CLMs were studied. The predictive power of estimated ICG-K of liver remnant (ICG-Krem) for subclinical PHI (peak bilirubin ≥3 mg/dL or refractory ascites) was compared with those of other potential predictors. The suggested safety limit of ICG-Krem ≥0.05 was also assessed.Receiver-operating curve analysis revealed that ICG-Krem [area under the curve (AUC) 0.752, cutoff 0.102] was the best predictor of subclinical PHI (AUC range for others was 0.632-0.668). Makuuchi's criteria corresponded to ICG-Krem 0.10. Subclinical PHI incidence was significantly elevated at ICG-Krem0.10 (26% vs 8%, p = 0.002), while potentially fatal PHI (peak bilirubin7 mg/dL) was not observed until down to ICG-Krem of 0.05.ICG-Krem sensitively predicts subclinical PHI. Liver failure-related death could be avoided so long as ICG-Krem remains at ≥0.05. However, patients with ICG-Krem 0.05-0.10 are at high risk of subclinical PHI and require intensive care postoperatively.
- Published
- 2020