The Results of СТ-Volumetry and Clearance Test with Indocyanine Green as Indications for Preoperative Portal Vein Embolization
https://doi.org/10.16931/1995-5464.2016334-46
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Abstract
Aim. To clarify the indications for preoperative portal vein embolization using CT-volumetry and indocyanine green clearance as predictors of post-resection liver failure.
Material and Methods. The results of 179 liver resections were analyzed. There were 128 hemihepatectomies and 51 partial resections. In 24 cases preoperative portal vein embolization was used. Indocyanine green clearance test was applied for a quantitative assessment of liver function. Plasma disappearance rate and residual concentration of indocyanine green during the first 15 minutes were determined. CT-volumetry was used to calculate the future remnant liver volume. Posthepatectomy liver failure severity was evaluated in accordance with the recommendations of the
International Study Group of Liver Surgery (ISGLS) and taking into account “50–50" criteria.
Results. The frequency of posthepatectomy liver failure after extensive resections was 42.5%: grade A – 38.7%; grade B –41.9%, grade C – 19.4%. The future remnant liver volume as a predictor of posthepatectomy liver failure had moderate predictive power (c-statistic = 0.71, p = 0.04) with sensitivity and specificity about 84.6% and 61%, respectively. Indocyanine green elimination was significantly worse in patients with chronic liver disease or after previous repeated courses of chemotherapy (plasma disappearance rate 15.6%/min vs 18.6%/min, p = 0.004; indocyanine green residual concentration after 15 minutes 19.6% vs 6,1%, p = 0.003). Clearance test with indocyanine green was characterized by
high sensitivity (92.3%) and specificity (71.4%) in the definition of liver function and excellent predictive power (c-statistic = 0.82, p = 0.0001) in determining of posthepatectomy liver failure. Risk factors of posthepatectomy liver failure were future remnant liver volume <372 cm3/m2 and plasma disappearance rate of indocyanine green <10%/min. The indications for preoperative portal vein embolization are future remnant liver volume <372 cm3/m2 at plasma
disappearance rate of indocyanine green >15%/min or plasma disappearance rate of indocyanine green >10%/min but
<15%/min and future remnant liver volume <550 cm3/m2. These criteria allowed to reduce the incidence of posthepatectomy liver failure (25.6%) and to avoid the development of severe liver dysfunction.
Conclusion. The future remnant liver volume and indocyanine green clearance test are highly sensitive methods to predict posthepatectomy liver failure. Application of the developed diagnostic and treatment algorithm with updated indications for preoperative portal vein embolization can reduce the frequency of posthepatectomy liver failure.
About the Authors
I. I. Dzidzava
Kirov Military Medical Academy, Ministry of Defence of the Russian Federation
Russian Federation
Doct. of Med. Sci., Assistant Professor
A. V. Slobodyanik
Kirov Military Medical Academy, Ministry of Defence of the Russian Federation
Russian Federation
Cand. of Med. Sci., Cheif of Surgical Department, Chair of Hospital Surgery
Kirov Military Medical Academy, Ministry of Defence of the Russian Federation
Russian Federation
Cand. of Med. Sci., Cheif of the Department of X-ray (CT) Diagnosis, Chair of Radiology with the Сourse of Ultrasonography
Kirov Military Medical Academy, Ministry of Defence of the Russian Federation
Russian Federation
Doct. of Med. Sci., Head of the Chair of Radiology with the Сourse of Ultrasonography
B. N. Kotiv
Kirov Military Medical Academy, Ministry of Defence of the Russian Federation
Russian Federation
Doct. of Med. Sci., Professor, Deputy Director of the Academy for Education and Research
Kirov Military Medical Academy, Ministry of Defence of the Russian Federation
Russian Federation
Doct. of Med. Sci., Assistant Professor of the Chair of General Surgery
Kirov Military Medical Academy, Ministry of Defence of the Russian Federation
Russian Federation
Doct. of Med. Sci., Assistant Professor of the Chair of General Surgery
Kirov Military Medical Academy, Ministry of Defence of the Russian Federation
Russian Federation
Surgeon of the
Surgical Department of the Clinic of Chair of Hospital Surgery
For citations:
Dzidzava I.I.,
Slobodyanik A.V.,
Kudryavtseva A.V.,
Zheleznyak I.S.,
Kotiv B.N.,
Alent'yev S.A.,
Lazutkin M.V.,
Soldatov S.A.
The Results of СТ-Volumetry and Clearance Test with Indocyanine Green as Indications for Preoperative Portal Vein Embolization. Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery. 2016;21(3):34-46.
(In Russ.)
https://doi.org/10.16931/1995-5464.2016334-46
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