Swiss HPB Center Zurich, Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland.
Department of General, Visceral and Transplant Surgery, University Medical Center Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany.
Langenbecks Arch Surg. 2023 Jul 5;408(1):264. doi: 10.1007/s00423-023-02983-5.
To assess the predictive value of intraoperative indocyanine green (ICG) test in patients undergoing staged hepatectomy.
We analyzed intraoperative ICG measurements of future liver remnant (FLR), preoperative ICG, volumetry, and hepatobiliary scintigraphy in 15 patients undergoing associated liver partition and portal vein ligation for staged hepatectomy (ALPPS). Main endpoints were the correlation of intraoperative ICG values to postoperative complications (Comprehensive Complication Index (CCI®)) at discharge and 90 days after surgery, and to postoperative liver function.
Median intraoperative R15 (ICG retention rate at 15 min) correlated significantly with CCI® at discharge (p = 0.05) and with CCI® at 90 days (p = 0.0036). Preoperative ICG, volumetry, and scintigraphy did not correlate to postoperative outcome. ROC curve analysis revealed a cutoff value of 11.4 for the intraoperative R15 to predict major complications (Clavien-Dindo ≥ III) with 100% sensitivity and 63% specificity. No patient with R15 ≤ 11 developed major complications.
This pilot study suggests that intraoperative ICG clearance determines the functional capacity of the future liver remnant more accurately than preoperative tests. This may further reduce the number of postoperative liver failures, even if it means intraoperative abortion of hepatectomy in individual cases.
评估术中吲哚菁绿（ICG）试验在分期肝切除患者中的预测价值。
我们分析了 15 例行联合肝脏离断和门静脉结扎的分期肝切除术（ALPPS）患者的术中 ICG 对未来肝（FLR）、术前 ICG、体积测量和肝胆闪烁扫描的测量值。主要终点是术中 ICG 值与术后并发症（综合并发症指数（CCI®））在出院时和术后 90 天的相关性，以及与术后肝功能的相关性。
中位术中 R15（15 分钟时的 ICG 保留率）与出院时的 CCI®显著相关（p=0.05），与术后 90 天的 CCI®显著相关（p=0.0036）。术前 ICG、体积测量和闪烁扫描与术后结果无关。ROC 曲线分析显示，术中 R15 的截断值为 11.4 可预测主要并发症（Clavien-Dindo≥III），具有 100%的敏感性和 63%的特异性。R15≤11 的患者无一例发生主要并发症。
这项初步研究表明，术中 ICG 清除率比术前检查更能准确地确定未来肝的功能容量。这甚至可能在个别情况下通过术中中止肝切除术来减少术后肝衰竭的数量。
