Predictive value of continuous monitoring of indocyanine green retention rate at 15 minutes combined with standard residual liver volume for hepatic insufficiency in patients with hepatocellular carcinoma after partial hepatectomy / 临床肝胆病杂志

ABSTRACT

ObjectiveTo investigate the value of continuous monitoring of indocyanine green retention rate at 15 minutes （ICG-R15） combined with standard residual liver volume （SRLV） in predicting hepatic insufficiency after partial hepatectomy. MethodsClinical data and SRLV data were collected from 70 patients with hepatocellular carcinoma who were admitted to Department of Hepatobiliary Surgery， Tianjin First Central Hospital， from November 2016 to May 2017. According to the presence or absence of hepatic insufficiency after surgery， the patients were divided into good liver function group with 56 patients and hepatic insufficiency group with 14 patients. Based on preoperative liver function evaluation and contrast-enhanced CT scans， resected liver volume and residual liver volume were calculated， and three-dimensional reconstruction of the liver was performed. Intraoperative ultrasound localization was performed to determine the surgical regimen， and selective hepatic inflow occlusion or intermittent hepatic portal occlusion was selected based on intraoperative conditions. CUSA combined with BIPOLAR drip electric coagulation forceps were used for the partition of liver parenchyma. SRLV was calculated， and ICG-R15 was monitored continuously. The independent-samples t test was used for comparison of continuous data between two groups， and the chi-square test was used for comparison of categorical data between two groups； the area under the ROC curve （AUC） was used to investigate the accuracy in predicting hepatic insufficiency after surgery. A multivariate Logistic regression analysis was used to establish a predictive model for postoperative hepatic insufficiency， and diagnostic criteria were developed for SLRV combined with postoperative ICG-R15 dynamic monitoring in the diagnosis of postoperative hepatic insufficiency. ResultsThere were significant differences between the two groups in ICG-R15 before surgery， immediately after surgery， and on days 3 and 5 after surgery， as well as significant differences in SRLV and Child class （all P<0.05）. The incidence rate of postoperative hepatic insufficiency increased with the increase in ICG-R15 before surgery， immediately after surgery， and on days 3 and 5 after surgery （all P<0.001）. Further comparison between two groups showed that there was a significant difference in the incidence rate of hepatic insufficiency between the ICG-R15>20% group and the other two groups before surgery， immediately after surgery， and on days 3 and 5 after surgery （all P<0.001）， and there was a significant difference in the incidence rate of hepatic insufficiency between the ICG-R15<10% group and the 10%≤ICG-R15≤20% group immediately after surgery （P<0.001）. ICG-R15 before surgery， ICG-R15 immediately after surgery， ICG-R15 on day 3 after surgery， and ICG-R15 on day 5 after surgery had an AUC of 0.790， 0.857， 0.855， and 0.870， respectively， in predicting postoperative hepatic insufficiency， and ICG-R15 immediately after surgery and on days 3 and 5 after surgery had a significantly larger AUC than ICG-R15 before surgery （all P<0.05）. The multivariate analysis showed that increases in SRLV and postoperative ICG-R15 dynamic monitoring （immediately after surgery and on days 3 and 5 after surgery） were independent risk factors for postoperative hepatic insufficiency， while increased body mass index before surgery was an independent protective factor （all P<0.05）. A multivariate Logistic regression predictive model was established and was used to predict hepatic insufficiency after surgery （immediately after surgery and on days 3 and 5 after surgery）， and the ROC curve analysis showed that the model had an AUC of 0.963， 0.967， and 0.967， respectively， in predicting hepatic insufficiency immediately after surgery and on days 3 and 5 after surgery （all P<0.01）. Diagnostic criteria were developed for SLRV combined with postoperative ICG-R15 dynamic monitoring in the diagnosis of postoperative hepatic insufficiency， i.e.， SLRV>1 240 mL/m2， ICG-R15>20% immediately after surgery， or ICG-R15>25% on day 3 or 5 after surgery， and postoperative hepatic insufficiency could be diagnosed if a patient met any one criterion. These diagnostic criteria had a sensitivity of 100%， a specificity of 60.71%， and a conformity degree of 68.57%. ConclusionContinuous monitoring of ICG-R15 before and after surgery is of guiding significance for predicting postoperative hepatic insufficiency， and ICG-R15 on day 5 after surgery has the highest accuracy. SRLV combined with postoperative ICG-R15 dynamic monitoring can effectively predict the onset of hepatic insufficiency after hepatectomy and can guide clinicians to predict the onset of postoperative hepatic insufficiency in patients with liver cancer and perform clinical intervention as soon as possible.