Langenbeck's Archives of Surgery · 6 authors, 4 centres
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This pilot study of 15 patients found that an intraoperative ICG retention rate (R15) measured during staged hepatectomy correlated significantly with postoperative complications, while preoperative tests did not. The study suggests intraoperative ICG may better assess the functional capacity of the future liver remnant than preoperative measures.
This pilot cohort study analyzed intraoperative ICG measurements in 15 patients undergoing ALPPS to predict postoperative complications. The primary outcome was the correlation of intraoperative R15 (ICG retention rate at 15 minutes) with the Comprehensive Complication Index (CCI®) at discharge and 90 days. A significant correlation was found between median intraoperative R15 and CCI® at discharge (p=0.05) and at 90 days (p=0.0036). ROC analysis identified an intraoperative R15 cutoff of 11.4 for predicting major complications with 100% sensitivity and 63% specificity; no patient with R15 ≤ 11 developed major complications. Preoperative ICG, volumetry, and scintigraphy did not correlate with outcomes. Limitations include the small sample size, a homogeneous patient group, and the inability to compare pre- and intraoperative ICG due to study design. The findings suggest intraoperative ICG may more accurately assess future liver remnant function than preoperative tests, potentially allowing for intraoperative abortion of hepatectomy to reduce postoperative liver failures.
