Predictive Value of Preoperative ICG-R15 Testing in Post-hepatectomy Liver Failure Following Major Liver Resection:...

Area of Science:

• Hepatobiliary surgery
• Surgical oncology
• Liver function testing

Background:

• Surgical resection is crucial for liver cancer but risks post-hepatectomy liver failure (PHLF).
• Pre-existing liver disease increases PHLF risk after major liver resection.
• Accurate preoperative assessment of liver function is vital for surgical planning.

Purpose of the Study:

• To evaluate the predictive value of the indocyanine green retention test at 15 minutes (ICG-R15) for PHLF.
• To identify independent risk factors for PHLF following major liver resection.
• To improve patient selection and surgical outcomes in liver cancer resection.

Main Methods:

• Retrospective review of 72 patients undergoing major liver resection with preoperative ICG-R15 testing (August 2021-January 2023).
• PHLF defined by ISGLS criteria; 90-day morbidity assessed.
• Univariate and multivariate logistic regression, ROC curve analysis used to identify predictors.

Main Results:

• PHLF occurred in 38.9% of patients (28/72), with 33.3% (24/72) as severity score B and 4.16% (3/72) as severity score C.
• Univariate analysis identified future liver remnant (FLR), ICG-R15, and blood transfusion as PHLF predictors.
• Multivariate analysis confirmed FLR (p=0.019) and ICG-R15 (p=0.032) as significant predictors; ROC analysis yielded an AUC of 0.642 for ICG-R15 with an optimal cut-point of 7.5.

Conclusions:

• Preoperative ICG-R15 is a valuable tool for assessing PHLF risk in patients undergoing major liver resection.
• Integrating ICG-R15 into preoperative evaluation aids in risk stratification, especially for patients with borderline FLR.
• Further prospective studies are needed to refine risk prediction models for PHLF.