Prospective blinded study on INTRAOPEATIVE ICG retention test for major hepatectomy – A direct functional measurement of future liver remnant

Abstract

Background: PRE-hepatectomy ICG study estimate overall liver function but does not measure the function of future liver remnant. Objective: This prospective single-centre study aims to evaluate the safe limited of ICG retention at 15 minutes during major hepatectomy after clamping of the hemi-liver inflow. Patients and methods: 98 patients had major liver resection for liver cancer and INTRA-operative ICG evaluation since 2010. All patients had preoperative ICG15 < 23%.The ICG retention rate of the future liver remnant was measured by LiMON pulse densitometry during major hepatectomy. Surgeon were blinded from ICG measurement. Result: 78 male and 20 females were included. 74 patients had hepatectomy for HCC and 11 patients had liver metastases. 71 Patients had Right hepatectomy, 18 patients had left hepatectomy, 6 patients and 3 patients had right trisectionectomy and left trisectionectomy respectively, 12 patients had ALPPS procedures. The median operation time was 351 minutes. The median blood loss was 0.8L. Despite good preoperative ICG15 measurement, 4 patients developed post hepatecotmy liver failure. 2 patients end up in mortality and 1 patient received rescue liver transplant. All of them had intraoperative ICG15 >50%. The risk of hospital mortality and postoperative morbidity increased from 1.1%% to 50% (P< 0.001) and from 20.2% to 100% (P=0.002) respectively if the intraoperative ICG15> 50%. Conclusion: Intraoperative ICG measurement is a quick and simple study that provide accurate functional measurement of future liver remnant. It provides surgeons a good last chance to adjust treatment plan in order to prevent post hepatectomy liver failure.