Volumetric analysis and indocyanine green retention rate at 15 min as predictors of post‐hepatectomy liver failure

Kim, Hee Joon; Kim, Choong Young; Park, Eun Kyu; Hur, Young Hoe; Koh, Yang Seok; Kim, Hyun Jong; Cho, Chol Kyoon

doi:10.1111/hpb.12295

Cited by 53 publications

(49 citation statements)

References 31 publications

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“…It is seldom reversible and results in significant post-operative morbidity and mortality. The prediction of PHLF/I today is still a science in evolution, with qualitative and quantitative assessment of FLR representing the basis for most predictive models in previous studies 171819…”

Section: Discussionmentioning

confidence: 99%

“…Our novel scoring system included routine pre-operative laboratory investigations commonly performed as part of a pre-hepatectomy workup. Pre-existing studies investigating predictive models for PHLF have largely centered around CT volumetric analysis and ICG R15 171819. Such an approach is undesirable given that these two investigations may not be readily available for clinical application or routinely carried out.…”

Section: Discussionmentioning

confidence: 99%

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Predictors of post-hepatectomy liver failure in patients undergoing extensive liver resections for hepatocellular carcinoma

Chin

Allen

Teo

et al. 2018

Ann Hepatobiliary Pancreat Surg

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Backgrounds/AimsTo determine the prevalence of post-hepatectomy liver failure/insufficiency (PHLF/I) in patients undergoing extensive hepatic resections for hepatocellular carcinoma (HCC) and to assess the predictive value of preoperative factors for post-hepatectomy liver failure or insufficiency (PHLF/I).MethodsA retrospective review of patients who underwent liver resections for HCC between 2001 and 2013 was conducted. Preoperative parameters were assessed and analyzed for their predictive value of PHLF/I. Definitions used included the 50–50, International Study Group of Liver Surgery (ISGLS) and Memorial Sloan Kettering Cancer Centre (MSKCC) criteria.ResultsAmong the 848 patients who underwent liver resections for HCC between 2001 and 2013, 157 underwent right hepatectomy (RH) and extended right hepatectomy (ERH). The prevalence of PHLF/I was 7%, 41% and 28% based on the 50–50, ISGLS and MSKCC criteria, respectively. There were no significant differences in PHLF/I between RH and ERH. Model for End-Stage Liver Disease (MELD) score and bilirubin were the strongest independent predictors of PHLF/I based on the 50–50 and ISGLS/MSKCC criteria, respectively. Predictive models were developed for each of the criteria with multiple logistic regression.ConclusionsMELD score, bilirubin, alpha-fetoprotein and platelet count showed significant predictive value for PHLF/I (all p<0.05). A composite score based on these factors serves as guideline for physicians to better select patients undergoing extensive resections to minimize PHLF.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Predictors of post-hepatectomy liver failure in patients undergoing extensive liver resections for hepatocellular carcinoma

Chin

Allen

Teo

et al. 2018

Ann Hepatobiliary Pancreat Surg

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“…29 In patients with chronic liver disease, some investigators have adopted algorithms incorporating functional tests, such as the indocyanine green retention rate, which has been proposed as an adjunct to the volumetric measurements. 30,31 However, despite encouraging results, widespread clinical acceptance is lacking so far.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, this group, and others, use a cutoff level of 25-30%, depending on individual patients' histories. 4,30,34 Determinants for a favourable outcome were identified as follows: there was a negative correlation between the detection of collaterals in follow-up CT and successful hypertrophy. Furthermore, there was a statistically significant correlation between "normal" PPLs and successful hypertrophy.…”

mentioning

confidence: 99%

Identification of cofactors influencing hypertrophy of the future liver remnant after portal vein embolization—the effect of collaterals on embolized liver volume

Zeile¹,

Bakal

Volkmer³

et al. 2016

The British Journal of Radiology

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Objective: The purpose of this retrospective study was to monitor hypertrophy of future liver remnant following portal vein embolization (PVE) before planned extended right hepatectomy. However, because individual responses to PVE are highly variable, our focus was to identify cofactors of successful hypertrophy. Methods: 28 patients with primary or secondary liver tumours, mean age 64.1 6 12.9 years, underwent PVE. Volumetric analysis of hypertrophy before and after PVE (median 39.0 6 15.7 days) was performed. The embolized liver segments were investigated for occurrence of reperfusion of their portal branches. Blood parameters before PVE were additionally investigated. Results: Patients were divided into responders (21/28) and non-responders (7/28) by post-PVE standardized future liver remnant being above or below 25%, respectively. No significant differences between the groups were found regarding biometric and volumetric parameters before PVE. In the entire group after PVE, the mean absolute increase of Segments 2 and 3 was 196.0 6 84.7 cm 3 and the median relative increase was 46.6 6 98.8%. The formation of left to right hepatic portoportal collaterals exhibited a negative correlation to successful hypertrophy (p 5 0.004) as well as low plasma total protein (p 5 0.019). Successful embolization of Segment IV showed only a trend to significance (p 5 0.098). Conclusion: Cofactors associated with a favourable outcome regarding hypertrophy were the absence of collaterals in the control CT scans and high plasma total protein. Advances in knowledge:Portoportal collaterals negatively influence hypertrophy after PVE. On the other hand, plasma total protein is a positive prognostic indicator on hypertrophy of the liver in our cohort.

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“…FLR volume measured pre‐operatively by three‐dimensional CT reconstruction can accurately reflect the size of the actual remnant liver . Patients with a smaller FLR are at a higher risk of developing PHLF . However, FLR volume does not exactly reflect the liver functional reserve of the FLR, which might be impaired by underlying liver parenchymal diseases, such as fibrosis, cirrhosis or steatosis.…”

Section: Introductionmentioning

confidence: 99%

Combining albumin‐bilirubin score with future liver remnant predicts post‐hepatectomy liver failure in HBV‐associated HCC patients

Zou

Wen

Yuan

et al. 2017

Liver International

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Volumetric analysis and indocyanine green retention rate at 15 min as predictors of post‐hepatectomy liver failure

Abstract: Regardless of ICG R15, an sFLR of ≥ 25% in patients without cirrhosis, and an sFLR of ≥ 25% with an sFLR : ICG R15 ratio of >1.9 in patients with cirrhosis indicate acceptable levels of safety in major hepatectomy.

Cited by 53 publications

References 31 publications

Predictors of post-hepatectomy liver failure in patients undergoing extensive liver resections for hepatocellular carcinoma

Predictors of post-hepatectomy liver failure in patients undergoing extensive liver resections for hepatocellular carcinoma

Identification of cofactors influencing hypertrophy of the future liver remnant after portal vein embolization—the effect of collaterals on embolized liver volume

Combining albumin‐bilirubin score with future liver remnant predicts post‐hepatectomy liver failure in HBV‐associated HCC patients

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