Iwaki K, Kaihara S, Kita R, Kitamura K, Hashida H, Uryuhara K. Indocyanine green plasma clearance rate and 99mTc-galactosyl human serum albumin single-photon emission computed tomography evaluated preoperative remnant liver. World J Clin Cases 2022; 10(25): 8844-8853 [PMID: 36157637 DOI: 10.12998/wjcc.v10.i25.8844]
Corresponding Author of This Article
Kentaro Iwaki, MD, Surgeon, Department of Surgery, Kobe City Medical Center General Hospital, 2-1-1 Minatojimaminamimachi, Chuo-ku, Kobe 650-0046, Hyogo, Japan. kentaro@kuhp.kyoto-u.ac.jp
Research Domain of This Article
Surgery
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Sep 6, 2022; 10(25): 8844-8853 Published online Sep 6, 2022. doi: 10.12998/wjcc.v10.i25.8844
Indocyanine green plasma clearance rate and 99mTc-galactosyl human serum albumin single-photon emission computed tomography evaluated preoperative remnant liver
Kentaro Iwaki, Satoshi Kaihara, Ryosuke Kita, Koji Kitamura, Hiroki Hashida, Kenji Uryuhara, Department of Surgery, Kobe City Medical Center General Hospital, Kobe 650-0046, Hyogo, Japan
Author contributions: Iwaki K designed and wrote the paper; Kaihara S supervised and the report; Kita R, Kitamura K, and Uryuhara K provided clinical advice; Hashida H contributed to the statistical analysis.
Institutional review board statement: This study was conducted in accordance with the Declaration of Helsinki following approval from the institutional review board of Kobe City Medical Center General Hospital (approval number: Zn191007).
Informed consent statement: Informed consent was obtained from all patients prior to their inclusion in this study.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No data can be available.
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: Kentaro Iwaki, MD, Surgeon, Department of Surgery, Kobe City Medical Center General Hospital, 2-1-1 Minatojimaminamimachi, Chuo-ku, Kobe 650-0046, Hyogo, Japan. kentaro@kuhp.kyoto-u.ac.jp
Received: January 15, 2022 Peer-review started: January 15, 2022 First decision: March 12, 2022 Revised: March 22, 2022 Accepted: July 24, 2022 Article in press: July 24, 2022 Published online: September 6, 2022 Processing time: 223 Days and 4 Hours
Abstract
BACKGROUND
Preoperative evaluation of future remnant liver reserves is important for safe hepatectomy. If the remnant is small, preoperative portal vein embolization (PVE) is useful. Liver volume analysis has been the primary method of preoperative evaluation, although functional examination may be more accurate. We have used the functional evaluation liver using the indocyanine green plasma clearance rate (KICG) and 99mTc-galactosyl human serum albumin single-photon emission computed tomography (99mTc-GSA SPECT) for safe hepatectomy.
AIM
To analyze the safety of our institution’s system for evaluating the remnant liver reserve.
METHODS
We retrospectively reviewed the records of 23 patients who underwent preoperative PVE. Two types of remnant liver KICG were defined as follows: Anatomical volume remnant KICG (a-rem-KICG), determined as the remnant liver anatomical volume rate × KICG; and functional volume remnant KICG (f-rem-KICG), determined as the remnant liver functional volume rate based on 99mTc-GSA SPECT × KICG. If either of the remnant liver KICGs were > 0.05, a hepatectomy was performed. Perioperative factors were analyzed. We defined the marginal group as patients with a-rem-KICG of < 0.05 and a f-rem-KICG of > 0.05 and compared the postoperative outcomes between the marginal and not marginal (both a-rem-KICG and f-rem-KICG > 0.05) groups.
RESULTS
All 23 patients underwent planned hepatectomies. Right hepatectomy, right trisectionectomy and left trisectionectomy were in 16, 6 and 1 cases, respectively. The mean of blood loss and operative time were 576 mL and 474 min, respectively. The increased amount of f-rem-KICG was significantly larger than that of a-rem-KICG after PVE (0.034 vs 0.012, P = 0.0273). The not marginal and marginal groups had 17 (73.9%) and 6 (26.1%) patients, respectively. The complications of Clavian-Dindo classification grade II or higher and post-hepatectomy liver failure were observed in six (26.1%) and one (grade A, 4.3%) patient, respectively. The 90-d mortality was zero. The marginal group had no significant difference in postoperative outcomes (prothrombin time/international normalised ratio, total bilirubin, complication, post-hepatectomy liver failure, hospital stay, 90-d, and mortality) compared with the not-marginal group.
CONCLUSION
Functional evaluation of the remnant liver enabled safe hepatectomy and may extend the indication for hepatectomy after PVE treatment.
Core Tip: Liver volume analysis has been a main examination; however, functional examination may be more accurate. This is a retrospective study to analyze the safety of our functional remnant liver evaluation system utilizing indocyanine green plasma clearance rate and 99mTc-galactosyl human serum albumin single-photon emission computed tomography. In this cohort, post-hepatectomy liver failure was observed in one case and 90-d mortality was zero. The system enables safe hepatectomies and extend the number of cases in which hepatectomy is indicated.
