Using indocyanine green test to avoid post-hepatectomy liver dysfunction.

BACKGROUND Post-operative hepatic failure is the most important concern for hepatocellular carcinoma (HCC) patients undergoing hepatectomy. The aim of this study was to determine the safe line of hepatectomy to prevent liver failure. METHOD Clinical profiles of 117 patients with HCC who underwent hepatectomies in Chang Gung Memorial Hospital from Jan. 2002 through Jun. 2003 were reviewed. Patients with heart disease, azotemia, intra-operative blood loss > or = 1500 ml or international ratio of prothrombin time > or = 1.2 were excluded. All 117 patients studied had preoperative 15-minute retention rates of ICG (ICG15). Whole liver volumes (LV) were calculated from the equation: LV (ml) = 706.2 x body surface area (BSA, m2) + 2.4. The resected liver volumes were measured by pathologists. Postoperative liver dysfunction was defined as an international prothrombin ratio of > or = 1.5. RESULTS Thirteen of the 117 HCC patients experienced postoperative liver dysfunction. The relationship between ICG15 retention rates and the ratio of remnant liver volume (RR) in the patients with postoperative liver dysfunction was established by regression, producing an equation: RR = 1.98 x ICG + 0.3672 (r = 0.92, p < 0.001). CONCLUSION Hepatectomies will be safer if the estimated ratio of remnant liver volume prior to surgery is higher than the calculated value of RR = 1.98 x ICG + 0.3672.