Background

Multidisciplinary treatment for colorectal liver metastases (CLMs) often includes major hepatectomy for preoperative chemotherapy-related hepatic injury, although the safety limit for resection extent is unclear. We investigated this parameter using the estimated indocyanine green clearance rate (ICG-K) of liver remnants, focusing on postoperative subclinical hepatic insufficiency (PHI).

Methods

Altogether, 225 patients who underwent resection of CLMs were studied. The predictive power of estimated ICG-K of liver remnant (ICG-Krem) for subclinical PHI (peak bilirubin ≥3 mg/dL or refractory ascites) was compared with those of other potential predictors. The suggested safety limit of ICG-Krem ≥0.05 was also assessed.

Results

Receiver-operating curve analysis revealed that ICG-Krem [area under the curve (AUC) 0.752, cutoff 0.102] was the best predictor of subclinical PHI (AUC range for others was 0.632–0.668). Makuuchi's criteria corresponded to ICG-Krem 0.10. Subclinical PHI incidence was significantly elevated at ICG-Krem <0.10 (26% vs 8%, p = 0.002), while potentially fatal PHI (peak bilirubin >7 mg/dL) was not observed until down to ICG-Krem of 0.05.

Conclusions

ICG-Krem sensitively predicts subclinical PHI. Liver failure-related death could be avoided so long as ICG-Krem remains at ≥0.05. However, patients with ICG-Krem 0.05–0.10 are at high risk of subclinical PHI and require intensive care postoperatively.

中文翻译：

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残留肝脏的吲哚菁绿清除率（ICG-Krem）预测结直肠肝转移切除术后的亚临床肝功能不全：Makuuchi标准安全扩展的理论验证。

背景

尽管对切除范围的安全性限制尚不清楚，但对大肠肝转移（CLM）的多学科治疗通常包括对术前与化疗相关的肝损伤进行大肝切除术。我们使用估计的肝脏残留吲哚菁绿清除率（ICG-K）来研究此参数，重点是术后亚临床肝功能不全（PHI）。

方法

总共研究了225例行CLM切除术的患者。将估计的肝残余ICG-K（ICG-Krem）对亚临床PHI（峰值胆红素≥3mg / dL或难治性腹水）的预测能力与其他潜在预测因子的预测能力进行了比较。还评估了ICG-Krem的建议安全极限≥0.05。

结果

接受者操作曲线分析显示，ICG-Krem [曲线下面积（AUC）0.752，截断范围0.102]是亚临床PHI的最佳预测指标（其他人的AUC范围为0.632–0.668）。Makuuchi的标准对应于ICG-Krem 0.10。在ICG-Krem <0.10时，亚临床PHI发生率显着升高（26％对8％，p = 0.002），而直到降至ICG-Krem为0.05时才观察到潜在的致命PHI（峰值胆红素> 7 mg / dL）。

结论

ICG-Krem可以灵敏地预测亚临床PHI。只要ICG-Krem保持≥0.05，就可以避免与肝衰竭相关的死亡。但是，ICG-Krem 0.05–0.10的患者发生亚临床PHI的风险很高，术后需要重症监护。