Value of indocyanine green clearance of the future liver remnant in predicting outcome after resection for biliary cancer

Yokoyama, Yukihiro; Nishio, Hisahide; Ebata, Tomoki; Igami, Tsuyoshi; Sugawara, Gen; Nagino, Masato

doi:10.1002/bjs.7084

Cited by 185 publications

(157 citation statements)

References 29 publications

(38 reference statements)

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“…As the resection volume of liver is different in each case, the future remnant liver volume should be considered case by case for prediction of postoperative liver function [135]. The ICG retention rate at 15min (ICGR15) or other ICG clearance tests are usually used as indicators for liver function [87,124,127,136,137]. ICG clearance test should be performed after relief of jaundice and cholangitis.…”

Section: Cq16: What Are Considered As Unresectable Factors In Biliarymentioning

confidence: 99%

Clinical practice guidelines for the management of biliary tract cancers 2015: the 2^nd English edition

Miyazaki

Yoshitomi

Miyakawa³

et al. 2015

J Hepato Biliary Pancreat

227

159

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Background The Japanese Society of Hepato-Biliary-Pancreatic Surgery launched the clinical practice guidelines for the management of biliary tract and ampullary carcinomas in 2008. Novel treatment modalities and handling of clinical issues have been proposed after the publication. New approaches for editing clinical guidelines, such as the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system, also have been introduced for better and clearer grading of recommendations. Methods Clinical questions (CQs) were proposed in seven topics. Recommendation, grade of recommendation and statement for each CQ were discussed and finalized by evidencebased approach. Recommendation was graded to grade 1 (strong) and 2 (weak) according to the concept of GRADE system. Results The 29 CQs covered seven topics: (1) prophylactic treatment, (2) diagnosis, (3) biliary drainage, (4) surgical treatment, (5) chemotherapy, (6) radiation therapy, and (7) pathology. In 27 CQs, 19 recommendations were rated strong and 11 recommendations weak. Each CQ included the statement of how the recommendation was graded. Conclusions This guideline provides recommendation for important clinical aspects based on evidence. Future collaboration with cancer registry will be a key for assessment of the guidelines and establishment of new evidence. Free full-text articles and a mobile application of this guideline are available via

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Section: Cq16: What Are Considered As Unresectable Factors In Biliarymentioning

confidence: 99%

Clinical practice guidelines for the management of biliary tract cancers 2015: the 2^nd English edition

Miyazaki

Yoshitomi

Miyakawa³

et al. 2015

J Hepato Biliary Pancreat

227

159

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“…5 ). sessment of volume, as indicated by an estimated value of the indocyanine green clearance rate from the future liver remnant (remnant ICGK) [13,24] . We previously reported that remnant ICGK 6 0.05 is a minimal requirement for safe hepatobiliary resection, and that PVE expands the proportion of patients with remnant ICGK 6 0.05 from 45 to 86% [13] .…”

Section: Staging and Survivalmentioning

confidence: 99%

“…Ebata/Yokoyama/Igami/Sugawara/ Takahashi/Nagino Dig Surg 2012;29:23-29 24 logic intervention for biliary cancer since 1990, developed a novel technique that included an ipsilateral approach [4] and trisegment PVE [5][6][7] , and investigated the changes in volume [8] , function [9] , and hemodynamics [10][11][12] .…”

mentioning

confidence: 99%

Portal Vein Embolization before Extended Hepatectomy for Biliary Cancer: Current Technique and Review of 494 Consecutive Embolizations

et al. 2012

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Backgrounds: Portal vein embolization (PVE) has been widely applied before extended hepatectomy; however, its clinical utility for patients with biliary cancer has not been fully addressed. Methods: Between 1991 and 2010, 494 patients with cholangiocarcinoma (n = 353) or gallbladder cancer (n = 141) underwent PVE before extended hepatectomy. PVE was performed by a transhepatic ipsilateral approach using fibrin glue or absolute ethanol with steel coils. Surgical outcomes of this cohort were retrospectively reviewed. Results: PVE-related complications requiring interventions were found in 3 (0.6%) of the 494 patients; no patient died of these complications. Among the 494 patients, 122 (24.7%) did not undergo subsequent hepatectomy. The unresectability rate was significantly higher in patients with gallbladder cancer than in those with cholangiocarcinoma [43.2% (61/141) and 17.3% (61/353), respectively, p < 0.001]. The remaining 372 patients underwent hepatectomy, and 24 (6.5%) died of postoperative complications [13 of 80 (16.3%) with gallbladder cancer vs. 11 of 292 (3.8%) with cholangiocarcinoma, p < 0.05]. The overall survival for patients with cholangiocarcinoma was significantly better than that for patients with gallbladder cancer, where the 5-year survival rate was 39 and 23%, respectively (p < 0.001). Thirty-six patients with cholangiocarcinoma and 10 patients with gallbladder cancer survived more than 5 years after extended surgery. Conclusion: PVE can be performed safely in patients with cholestatic liver, and it has a potential benefit for patients with advanced biliary cancer who are to undergo extended, difficult hepatectomy.

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“…PHLF is closely related to the volume and function of the remnant liver, and these two variables are the major determinants of the adequacy of future remnant liver (FRL) after resection [10]. In patients with normal liver, smaller FRL volume can be adequate for a rapid recovery after resection.…”

Section: Introductionmentioning

confidence: 99%

How Much Remnant Is Enough in Liver Resection?

Guglielmi¹,

Ruzzenente²,

Conci³

et al. 2012

Dig Surg

281

193

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Background: Liver resection represents the first choice of treatment for primary and secondary liver malignancies, offering the patient the best chance of long-term survival. The extensive use of major hepatectomy increases the risk of post-hepatectomy liver failure (PHLF), which is associated with a high frequency of postoperative complications, mortality and increased length of hospital stay. Aims: The aim of this review is to investigate the different risk factors related to the occurrence of PHLF and to identify the limits for a safe liver resection in patients with normal liver and injured liver (cirrhosis, cholestasis, steatosis and post-chemotherapy liver injury). Methods: A literature search was undertaken in PubMed and related search engines, looking for articles relating to hepatic failure following hepatectomy in normal liver or injured liver. Results: In spite of improvements in surgical and postoperative management, the parameters determining how much liver can be resected are still largely undefined. A number of preoperative, intraoperative and postoperative factors all contribute to the likelihood of liver failure after surgery. The safe limits for liver resection can be estimated from the data of the literature for patients with normal liver and for those with different types of liver injury. Conclusions: Preoperative assessment that includes evaluation of liver volume and function of the remnant liver is a mandatory prerequisite before major hepatectomy. The critical residual liver volume for patients able to predict PHLF is mainly related to the presence of pre-existing liver disease and liver function. Among patients with normal liver, the limit for safe resection ranges from 20 to 30% future remnant liver of total liver volume. In patients with injured liver (cirrhosis, cholestasis or steatosis), preoperative assessment of the risk of PHLF should include future remnant liver volumetry and accurate liver function evaluation, including different dynamic liver function tests.

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Value of indocyanine green clearance of the future liver remnant in predicting outcome after resection for biliary cancer

Abstract: An ICGK-F of 0.05 is a useful cut-off value for predicting mortality and morbidity. With careful perioperative patient management in an experienced institution, this cut-off value can be lowered further.

Cited by 185 publications

References 29 publications

Clinical practice guidelines for the management of biliary tract cancers 2015: the 2^nd English edition

Clinical practice guidelines for the management of biliary tract cancers 2015: the 2^nd English edition

Portal Vein Embolization before Extended Hepatectomy for Biliary Cancer: Current Technique and Review of 494 Consecutive Embolizations

How Much Remnant Is Enough in Liver Resection?

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Value of indocyanine green clearance of the future liver remnant in predicting outcome after resection for biliary cancer

Abstract: An ICGK-F of 0.05 is a useful cut-off value for predicting mortality and morbidity. With careful perioperative patient management in an experienced institution, this cut-off value can be lowered further.

Cited by 185 publications

References 29 publications

Clinical practice guidelines for the management of biliary tract cancers 2015: the 2nd English edition

Clinical practice guidelines for the management of biliary tract cancers 2015: the 2nd English edition

Portal Vein Embolization before Extended Hepatectomy for Biliary Cancer: Current Technique and Review of 494 Consecutive Embolizations

How Much Remnant Is Enough in Liver Resection?

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Clinical practice guidelines for the management of biliary tract cancers 2015: the 2^nd English edition

Clinical practice guidelines for the management of biliary tract cancers 2015: the 2^nd English edition