Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 6, 2022; 10(25): 8844-8853
Published online Sep 6, 2022. doi: 10.12998/wjcc.v10.i25.8844
Indocyanine green plasma clearance rate and 99mTc-galactosyl human serum albumin single-photon emission computed tomography evaluated preoperative remnant liver
Kentaro Iwaki, Satoshi Kaihara, Ryosuke Kita, Koji Kitamura, Hiroki Hashida, Kenji Uryuhara
Kentaro Iwaki, Satoshi Kaihara, Ryosuke Kita, Koji Kitamura, Hiroki Hashida, Kenji Uryuhara, Department of Surgery, Kobe City Medical Center General Hospital, Kobe 650-0046, Hyogo, Japan
Author contributions: Iwaki K designed and wrote the paper; Kaihara S supervised and the report; Kita R, Kitamura K, and Uryuhara K provided clinical advice; Hashida H contributed to the statistical analysis.
Institutional review board statement: This study was conducted in accordance with the Declaration of Helsinki following approval from the institutional review board of Kobe City Medical Center General Hospital (approval number: Zn191007).
Informed consent statement: Informed consent was obtained from all patients prior to their inclusion in this study.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No data can be available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Kentaro Iwaki, MD, Surgeon, Department of Surgery, Kobe City Medical Center General Hospital, 2-1-1 Minatojimaminamimachi, Chuo-ku, Kobe 650-0046, Hyogo, Japan. kentaro@kuhp.kyoto-u.ac.jp
Received: January 15, 2022
Peer-review started: January 15, 2022
First decision: March 12, 2022
Revised: March 22, 2022
Accepted: July 24, 2022
Article in press: July 24, 2022
Published online: September 6, 2022
Processing time: 223 Days and 4 Hours
ARTICLE HIGHLIGHTS
Research background

Liver volume analysis has been the primary method of preoperative evaluation, although some studies reported that functional examination may be more accurate.

Research motivation

In our institution, we have used the remnant liver functional volume for preoperative assessment since 2004. We analyzed the validity of our remnant liver evaluation system.

Research objectives

In total, 150 patients underwent 99mTc galactosyl human serum albumin single-photon emission computed tomography and hepatectomy at our institution from 2004 to 2019. Within this cohort, 23 patients who underwent preoperative portal vein embolization (PVE) were enrolled.

Research methods

First, the perioperative factors and changes in the remnant liver indocyanine green plasma clearance rate (KICG) after PVE were reviewed. Second, we defined the marginal group and the not-marginal group. We then compared the postoperative outcomes between the marginal and not-marginal groups to evaluate the safety of hepatectomy for the marginal group.

Research results

All 23 patients underwent planned hepatectomies. Right hepatectomy, right trisectionectomy, and left trisectionectomy were performed in 16, 6, and 1 case, respectively. The increased amount of remnant functional KICG was significantly larger than that of remnant anatomical KICG after PVE (0.034 vs 0.012, P = 0.0273). The not-marginal and marginal groups comprised 17 (73.9%) and 6 (26.1%) patients, respectively. The complications of Clavian-Dindo classification grade II or higher and post-hepatectomy liver failure were observed in six (26.1%) and one (grade A, 4.3%) patient, respectively. The 90-d mortality was zero. The postoperative outcomes were not significantly different between the marginal and not-marginal groups.

Research conclusions

Functional evaluation of the remnant liver enabled safe hepatectomy and may extend the indication for hepatectomy after PVE.

Research perspectives

We consider to increase the sample size and investigate appropriate remnant liver functional KICG cutoff values.