Copyright
©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
Laboratory scoring system to predict hepatic indocyanine green clearance ability during fluorescence imaging-guided laparoscopic hepatectomy
Zhen-Rong Chen, Qing-Teng Zeng, Ning Shi, Hong-Wei Han, Zhi-Hong Chen, Yi-Ping Zou, Yuan-Peng Zhang, Fan Wu, Lian-Qun Xu, Hao-Sheng Jin
Zhen-Rong Chen, Ning Shi, Yuan-Peng Zhang, Fan Wu, Hao-Sheng Jin, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510000, Guangdong Province, China
Zhen-Rong Chen, Ning Shi, Hong-Wei Han, Zhi-Hong Chen, Yi-Ping Zou, Yuan-Peng Zhang, Fan Wu, Lian-Qun Xu, Hao-Sheng Jin, Department of General Surgery, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510000, Guangdong Province, China
Qing-Teng Zeng, Department of Hepatobiliary Surgery, Shenzhen Hospital of Traditional Chinese Medicine, Shenzhen 518000, Guangdong Province, China
Zhi-Hong Chen, Yi-Ping Zou, Medical College, Shantou University, Shantou 515000, Guangdong Province, China
Author contributions: Chen ZR, Zeng QT, and Shi N contributed equally to this study. Chen ZR, Zeng QT, and Han HW designed the study; Chen ZR and Han HW collected the clinically relevant data, obtained, outlined, and measured the fluorescence intensity values of the intraoperative images; Chen ZH and Zou YP were responsible for the statistical analysis; Chen ZH, Zou YP, and Shi N drafted the manuscript; and all authors revised the manuscript; Shi N and Jin HS were responsible for critical review of the research and articles.
Supported by the National Key Clinical Specialty Construction Project of China, No. 2022YW030009.
Institutional review board statement: This study was conducted in accordance with the Declaration of Helsinki and approved by the Medical Ethics Committee of Guangdong Provincial People’s Hospital.
Clinical trial registration statement: This study was registered in the Chinese Clinical Trials Registry (
https://www.chictr.org.cn/), registration number: ChiCTR2200056978.
Informed consent statement: Informed consent was obtained from each enrolled patient before entering this study.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
CONSORT 2010 statement: The authors have read the CONSORT 2010 statement, and the manuscript was prepared and revised according to the CONSORT 2010 statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Hao-Sheng Jin, PhD, Professor, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, No. 106 Zhongshan 2nd Road, Yuexiu District, Guangzhou 510000, Guangdong Province, China. kinghaos@126.com
Received: February 13, 2023
Peer-review started: February 13, 2023
First decision: March 28, 2023
Revised: April 11, 2023
Accepted: May 6, 2023
Article in press: May 6, 2023
Published online: July 27, 2023
ARTICLE HIGHLIGHTS
Research background
The preoperative regimen of indocyanine green (ICG) administration in laparoscopic hepatectomy was still controversial. Factors associated with tumor fluorescence staining effect were unclear.
Research motivation
Establish a novel laboratory scoring system to screen specifical patients who need ICG dose adjustment.
Research objectives
Establish a risk model that can predict the effect of liver ICG preoperative staining through clinical indicators, and reduce the probability of ICG staining failure events.
Research methods
All enrolled patients received 5 mg ICG 24 h before laparoscopic hepatectomy, then investigate the predictive indicators of ICG fluorescence characteristics and established a laboratory risk model to identify individuals at high risk for high liver background fluorescence.
Research results
Pre-operative aspartate aminotransferase, alanine aminotransferase, gamma-glutamyl transpeptidase, adenosine deaminase, and lactate dehydrogenase were positively associated with fluorescence intensity of background liver (FI-LB) and pre-operative red blood cell, cholinesterase, and were negatively associated with FI-LB. Total laboratory risk score (TLRS) was calculated according to receiver operating characteristic (ROC) curve [area under the ROC curve (AUC) = 0.848, sensitivity = 0.773, specificity = 0.885]. When TLRS was greater than 6.5, the liver clearance ability of ICG was considered as poor.
Research conclusions
Common preoperative laboratory blood parameters can be used to predict liver ICG clearance. The established risk prediction model helps to identify individuals who may be at risk of fluorescent staining failure. Surgeons can calculate the risk value of high liver background fluorescence intensity based on relevant blood indicators, so as to adjust the dose and time of ICG before operation, and finally obtain better liver fluorescence staining.
Research perspectives
More effective clinical indicators (including preoperative ultrasound or radiographic examination characteristics, blood tumor indicators, etc.) are expected to be added to the model for predicting liver ICG fluorescence staining, further improving the accuracy of the model, and thus obtaining greater clinical application value.
