Background & objective: Accurate estimation of liver reserve function before hepatectomy for liver cancer may avoid postoperative liver failure. Recently,it has been considered that indocyanine green retention rate at 15 minutes (ICG(R15))can assess liver reserve function with exactitude and high sensitivity. This study was to discuss the evaluation of liver cirrhosis severity and liver reverse function by ICG(R15), analyze the relationship between ICG(R15) and post-operative liver failure,and compare ICG(R15) with Child-Pugh grading.
Methods: Records of 225 patients with resected hepatocellular carcinoma (HCC)have been collected. Pre-operative data, such as a variety of routine liver biochemistry tests, Child-Pugh grading, and ICG(R15) value, and intra-operative data, post-operative data were analyzed.
Results: The mean value of ICG(R15) was (9.9+/-6.2)% in cirrhosis group,and (7.4+/-3.8)% in non-cirrhosis group (P< 0.01). The mean value of ICG(R15) was (8.5+/-5.0)% in mild cirrhosis subgroup, (10.7+/-5.7)% in moderate cirrhosis subgroup, and (15.8+/-9.6)% in severe cirrhosis subgroup; significant differences can be observed while multiple comparisons were performed (P< 0.05). The mean values of ICG(R15) in patients who suffered from post-operative ascites, and jaundice were (11.5+/-6.8)%,and (12.1+/-7.1)%; significantly higher than those without ascites, and jaundice [(8.5+/-4.9)%,and (9.0+/-5.3)%] (P< 0.05). Possible predictor variables indicating risk factors of post-operative complications were entered into a multiple logistic regression model, the results showed that ICG(R15) significantly affected the occurrence of both post-operative ascites and jaundice (P< 0.05). The mean value of ICG(R15) of patients of Child-Pugh B grade was (15.2+/-8.6)%, much higher than that of patients of Child-Pugh A grade [(8.8+/-5.1)%](P< 0.01). ICG(R15) values were above 10% in 67 of the 212 patients of Child-Pugh A grade, and 6 of these 67 patients have a value above 20%.
Conclusions: ICG(R15) value rises with the aggravation of liver cirrhosis,it affects the occurrence of post-operative liver failure significantly. Some correlation can be observed between ICG(R15) and Child-Pugh grading.