Indocyanine green clearance of remnant liver (ICG-Krem) predicts postoperative subclinical hepatic insufficiency after resection of colorectal liver metastasis: theoretical validation for safe expansion of Makuuchi's criteria

Kobayashi, Yuta; Kiya, Yoshitaka; Hashimoto, Masaji

doi:10.1016/j.hpb.2019.06.013

Cited by 27 publications

(25 citation statements)

References 24 publications

(22 reference statements)

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“…contributes to better survival outcomes for CLM,(1) the complexity of liver surgery and aggressive chemotherapy still remain the main cause of morbidity and mortality (5,33,34). To ensure perioperative safety, meticulous preoperative workup including assessment of hepatic functional reserve and 3D volumetry has conventionally been performed to mainly avoid the risk of postoperative hepatic insufficiency (18,35,36) However, given the increasing awareness of the importance of nutritional/inflammatory status, preoperative assessment would need to be more comprehensive to adequately assess the surgical risks based on the patients' physical status. This study aimed to compare the performance of various nutritional/inflammatory scores and to investigate the most efficient evaluation method from the standpoint of reliability and usability.…”

Section: Discussion Discussionmentioning

confidence: 99%

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Comparison of Nutritional/Inflammatory Scores as a Preoperative Predictor of Short-Term Surgical Risks in Hepatectomy for Colorectal Metastasis

Umino¹,

Shindoh²,

Kobayashi³

et al. 2021

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Background: Various nutritional/inflammatory scores reportedly correlate with surgical outcomes of abdominal surgery, while it remains inconclusive which one is the best in prediction of short-term surgical outcomes of patients with colorectal liver metastasis (CLM). Methods: Clinical records of 367 hepatectomies for 267 patients with CLM were retrospectively reviewed. Preoperative nutritional/inflammatory status was determined using 14 reported nutritional/inflammatory scores and predictive powers of these scores for short-term surgical outcomes were compared. Results: In receiver operating characteristics curve analysis, controlling nutritional status (CONUT) score showed the highest performance in prediction of major postoperative morbidity (area under the curve [AUC], 0.650) among the tested scores and similar tendency was also confirmed in prediction of global postoperative morbidity (AUC, 0.622). Multivariate analysis confirmed that the CONUT score showed significant correlation with both global morbidity (odds ratio [OR], 1.29; 95% CI, 1.11-1.49, P=0.001) and major morbidity (OR, 1.31; 95% CI, 1.08-1.60; P=0.006). When preoperative degree of malnutrition was classified into normal, light, and moderate according to the original CONUT scoring system, short-term surgical outcomes were well stratified as follows: any morbidity, 21.8% vs. 35.1% vs. 51.9% (P=0.001); major morbidity, 6.2% vs. 11.7% vs. 29.6% (P=0.002); and postoperative hospital stay, 11 days vs. 11 days vs. 12 days (P=0.006). Conclusions: The CONUT score could be a simple and reliable predictor of short-term surgical outcomes of patients undergoing hepatectomy for CLM.

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Section: Discussion Discussionmentioning

confidence: 99%

“…Our indication criteria for surgical resection of CLM has been reported elsewhere (18). Briefly, preoperative hepatic functional reserve was assessed using indocyanine green (ICG) clearance test in addition to general blood examinations.…”

Section: Methods Methodsmentioning

confidence: 99%

Comparison of Nutritional/Inflammatory Scores as a Preoperative Predictor of Short-Term Surgical Risks in Hepatectomy for Colorectal Metastasis

Umino¹,

Shindoh²,

Kobayashi³

et al. 2021

SGO

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“…Details of our surgical indications are reported elsewhere . Briefly, surgery with curative intent was considered for those who fulfilled the following three criteria: (a) no or controllable ascites; (b) serum total bilirubin level of ≤2.0 mg/dL; and (c) estimated indocyanine green clearance rate of the full‐functioning future liver remnant (ICG‐Krem) ≥0.05.…”

Section: Methodsmentioning

confidence: 99%

A novel scoring system for evaluating the difficulty of lysis of adhesion and surgical risk at repeat hepatectomy

Kobayashi

Igata

Okubo

et al. 2020

J Hepato Biliary Pancreat

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Background Repeat hepatectomy (ReHx) for recurrent hepatic malignancies reportedly provides oncological benefit for patients. However, severe adhesions at the time of ReHx may preclude safe and curative resection and there has been no reliable measure to estimate the surgical risk at ReHx. This study sought to create a new scoring system for evaluating the severity of adhesion after hepatectomy and tested its performance looking at the correlation with morbidity rate. Methods Operative videos of 66 patients undergoing a second hepatectomy were reviewed and the difficulty levels in lysis of adhesion around the hepatic hilum (A score) and surrounding the liver (B score) were scored by two examiners and validated by two additional reviewers. Results Very high interobserver agreement was confirmed between the two examiners (κ value, 0.960‐0.963) and reproducibility of results were validated with weighted kappa values of >0.8 in both surgical resident and hepatobiliary surgeon. Linear correlation was confirmed between the difficulty score and postoperative morbidity rate. Multivariate analyses confirmed that previous cholecystectomy or transection of visceral surface of segment 4 or 5 was an independent factor predicting hard to extreme adhesions at the hepatic hilum regardless of the use of anti‐adhesion materials. Conclusions The new difficulty scoring system for the lysis of adhesion at ReHx showed good interobserver agreement and reproducibility of the results. Given the strong correlation with postoperative morbidity rate, the present score could be used for evaluating the technical difficulties in ReHx and may offer a reliable measure for estimating the efficacy of anti‐adhesion materials in future analysis.

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“…Although most patients with CLM are not affected by chronic liver disease, prolonged chemotherapy is reportedly associated with increased risk of sinusoidal injury or steatohepatitis, 8 and hepatic functional reserve is frequently influenced as the cycle of chemotherapy increases. 20,21 Also, major hepatectomy is frequently required especially in conversion cases with multiple CLMs. Therefore, preoperative workup should include evaluation of hepatic functional reserve and volumetry to avoid liver-related morbidities after surgery.…”

Section: Technical Resectabilit Y and Oncological Resectabilit Ymentioning

confidence: 99%

“…Technical resectability criteria include (a) expectation of margin‐negative resection (ie, R0 resection) and (b) anticipation to preserve sufficient volume of future liver remnant. Although most patients with CLM are not affected by chronic liver disease, prolonged chemotherapy is reportedly associated with increased risk of sinusoidal injury or steatohepatitis, 8 and hepatic functional reserve is frequently influenced as the cycle of chemotherapy increases 20,21 . Also, major hepatectomy is frequently required especially in conversion cases with multiple CLMs.…”

Section: Technical Resectability and Oncological Resectabilitymentioning

confidence: 99%

Risk stratification and goal of systemic therapy for successful surgical management of colorectal liver metastases: Oncological optimization

Shindoh

2021

J Hepato Biliary Pancreat

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For patients with stage IV colorectal cancer (CRC), curative‐intent surgery has actively been performed for expecting prolonged survival outcomes. However, because the population with stage IV CRC is considerably heterogeneous, optimal selection of surgical candidate is inevitable to maximize survival outcomes. In the era of effective chemotherapy, there is an increasing need for a strategic use of chemotherapy as a part of multidisciplinary treatment to expand surgical indications and enhance the clinical outcomes. However, since the fate of each patient is difficult to predict at initial presentation, our clinical practice is rather “tailored”, considering the anatomy, oncological behavior of tumor, response to chemotherapy, and patient's physical status. Given that surgery is the only treatment option for expecting cure of colorectal liver metastases (CLM), the main purpose of chemotherapy for potentially/marginally resectable disease is to clarify the likelihood of surgical benefit through testing the behavior of the tumor and to select an appropriate candidate for surgery. This process of clinical decision is actually optimization of the initial population for surgery through the optimization of treatment for each patient. In this article, theoretical bases of multidisciplinary management for CLM were revisited and the concept of “oncological optimization” underling our clinical decision was discussed.

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Indocyanine green clearance of remnant liver (ICG-Krem) predicts postoperative subclinical hepatic insufficiency after resection of colorectal liver metastasis: theoretical validation for safe expansion of Makuuchi's criteria

Cited by 27 publications

References 24 publications

Comparison of Nutritional/Inflammatory Scores as a Preoperative Predictor of Short-Term Surgical Risks in Hepatectomy for Colorectal Metastasis

Comparison of Nutritional/Inflammatory Scores as a Preoperative Predictor of Short-Term Surgical Risks in Hepatectomy for Colorectal Metastasis

A novel scoring system for evaluating the difficulty of lysis of adhesion and surgical risk at repeat hepatectomy

Risk stratification and goal of systemic therapy for successful surgical management of colorectal liver metastases: Oncological optimization

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