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《Chinese Journal of Cancer》 2005-03
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Estimation of Hepatic Resection Volume in Hepatocellular Carcinoma by ICG_(R15) and Its Relation with Postoperative Liver Failure

LAO Xiang-Ming, ZHANG Ya-Qi, LIN Xiao-Jun, GUO Rong-Ping, CHEN Min-Shan, YUAN Yun-Fei, LI Jin-Qing, LI Guo-Hui Department of Hepatobiliary, Cancer Center, Sun Yat-sen University, Guangzhou, Guangdong, 510060, P.R.China  
BACKGROUND OBJECTIVE: It is important to accurately estimate liver reserve function before hepatectomy for hepatocellular carcinoma (HCC), and to determine proper hepatic resection volume during operation, thus, to avoid postoperative liver failure. Recently, indocyanine green retention rate at 15 min (ICGR15) has been considered as a sensitive marker for liver reserve function. However, how to evaluate the maximal hepatic resection volume according to liver reserve function, especially ICGR15, remains controversial. This study was to evaluate the influence of ICGR15 and hepatic resection volume on postoperative liver failure. METHODS: Records of 225 HCC patients who underwent hepatectomy were retrospectively reviewed. Preoperative ICGR15 value, intraoperative hepatic resection volume, and postoperative liver function were analyzed. RESULTS: Of the 225 patients, 113 received resection of no more than 1 segment (group A), 76 received resection of 1-2 segments (group B), 36 received resection of more than 2 segments (group C). When ICGR15 was below 10%, the incidences of postoperative ascites in groups A, B, and C were 21.2% (14/66), 14.3% (8/56), and 15.4% (4/26), respectively (P0.05); the incidences of jaundice were 3.0% (2/66), 7.1% (4/56), and 15.4% (4/26), respectively (P0.05). When ICGR15 was 10%-20%, the incidences of ascites were 26.8% (11/41), 38.9%(7/18), and 50.0% (5/10), respectively (P0.05); the incidence of jaundice was lower in group A than in group B, and group C [0 (0/41) vs. 27.8% (5/18), and 20.0% (2/10), P0.01]; 2 patients, who had 2 or 3 segments resected, died of postoperative encephalopathy. When ICGR15 was more than 20%, ascites occurred in 2 of 6 patients (33.3%) in group A; both of the 2 cases in group B developed postoperative ascites and jaundice, and 1 died. CONCLUSIONS: When ICGR15 is below 10%, 2 or more segments can be resected safely; when ICGR15 is 10%-20%, 1 segment can be resected safely, 2 or more segments may be resected with great care; when ICGR15 is more than 20%, the patient's general condition and other liver function tests should be taken into consideration if 1 segment is resected, resection of 2 or more segments will cause high surgical risk.
【CateGory Index】: R735.7
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