Granieri Stefano, Bracchetti Greta, Kersik Alessia, Frassini Simone, Germini Alessandro, Bonomi Alessandro, Lomaglio Laura, Gjoni Elson, Frontali Alice, Bruno Federica, Paleino Sissi, Cotsoglou Christian
General Surgery Unit, Vimercate Hospital, ASST Vimercate, Azienda Socio Sanitaria Territoriale della Brianza, Via Santi Cosma e Damiano, 10, Vimercate, MB 20871, Italy.
General Surgery Unit, Vimercate Hospital, ASST Vimercate, Azienda Socio Sanitaria Territoriale della Brianza, Via Santi Cosma e Damiano, 10, Vimercate, MB 20871, Italy; University of Milan, Via Festa del Perdono, 7, Milan 20122, Italy.
Photodiagnosis Photodyn Ther. 2022 Dec;40:103170. doi: 10.1016/j.pdpdt.2022.103170. Epub 2022 Oct 24.
Post hepatectomy liver failure (PHFL) still represents a potentially fatal complication after major liver resection. Indocyanine green (ICG) clearance test represents one of the most widely adopted examinations in the preoperative workup. Despite a copious body of evidence which has been published on this topic, the role of ICG in predicting PHLF is still a matter of debate.
A systematic review of the literature was conducted according to PRISMA-DTA guidelines. The primary outcome was the assessment of diagnostic performance of ICG in predicting PHLF. The secondary outcome was the mean ICG and ICG in patients experiencing PHLF.
Seventeen studies, for a total of 4852 patients, were deemed eligible. Sensitivity ranged from 25% to 83%; Specificity ranged from 66.1% to 93.8%. ICG clearance test pooled AUC was 0.673 (95% CI: 0.632-0.713). The weighted mean ICG was 11 (95%CI: 8.3-13.7). The weighted mean ICG was 16.5 (95%CI: 13.3-19.8). High risk of bias was detected in all examined domains.
Preoperative ICG clearance test alone may not represent a reliable method to predict post hepatectomy liver failure. Its diagnostic significance should be framed within multiparametric models involving clinical and imaging features.
肝切除术后肝衰竭（PHFL）仍是大肝切除术后潜在的致命并发症。吲哚菁绿（ICG）清除试验是术前检查中应用最广泛的检查之一。尽管关于该主题已发表了大量证据，但ICG在预测PHLF中的作用仍存在争议。
根据PRISMA-DTA指南对文献进行系统综述。主要结局是评估ICG预测PHLF的诊断性能。次要结局是发生PHLF患者的平均ICG和ICG值。
共纳入17项研究，总计4852例患者。敏感性范围为25%至83%；特异性范围为66.1%至93.8%。ICG清除试验合并AUC为0.673（95%CI：0.632-0.713）。加权平均ICG为11（95%CI：8.3-13.7）。加权平均ICG为16.5（95%CI：13.3-19.8）。在所有检查领域均检测到高偏倚风险。
单独的术前ICG清除试验可能不是预测肝切除术后肝衰竭的可靠方法。其诊断意义应在涉及临床和影像学特征的多参数模型中进行考量。
