Benefit to Perform Indocyanine Green Clearance Test: Reply

Excerpt

We appreciate kind and insightful comments by Drs. Olthof, Coelen, and van Gulik. In 2010, we published a paper reporting the usefulness of indocyanine green clearance of the future liver remnant (ICGK-F) in predicting outcome after resection for biliary cancer [1]. ICGK-F is calculated as plasma clearance rate of indocyanine green × proportion of the future liver remnant measured by CT volumetry. In multiple logistic regression analyses, an ICGK-F <0.05 had strong impact on the incidence of postoperative mortality (odds ratio 8.06, p < 0.001). Therefore, as institutional policy, we have been using the cutoff of ICGK-F 0.05 for the operative indication. When patient’s ICGK-F is below 0.05, we perform portal vein embolization (PVE) to increase the volume of future liver remnant. After the PVE, the value of ICG clearance test generally does not change; thus, the value of ICGK-F eventually increases. Since the previous study included old cases (since 1991), the current study intended to re-evaluate the validity of ICGK-F with recent cases. Five hundred and eighty-five patients who underwent major hepatectomy with extrahepatic bile duct resection from 2002 to 2014 were included. In this period, the postoperative mortality rate was significantly lower compared to that in the earlier period. By consistent use of ICGK-F as a criterion to determine the operative indication, we have been achieving an acceptable mortality rate (2 %) following a challenging surgery such as a major hepatectomy with extrahepatic bile duct resection. It should be noted that 42 % (243/585) underwent combined vascular resection and 15 % (87/585) underwent combined pancreatoduodenectomy in this series. These results indicate the validity of our cutoff (ICGK-F 0.05) in assessing the future liver remnant function and in preventing postoperative mortality. …