Preoperative detection of liver functional reserve in patients with hilar cholangiocarcinoma using the indocyanine green retention test

Objective To study the use of preoperative indocyanine green retention test at 15 minutes (ICG R15) in the prediction of liver functional reserve in patients with hilar cholangiocarcinoma (HCCA). Methods The clinical data of 62 patients with HCCA treated in our department from March 2016 to March 2018 was reviewed. The relationship between preoperative ICG R15 and postoperative hepatic insufficiency was analyzed. The relationship between preoperative ICG R15 and Child-Pugh scoring was also studied. Univariate analysis was used to evaluate the risk factors of postoperative liver dysfunction. Logistic regression was used to assess the independent risk factors of postoperative liver dysfunction. The regression equation between independent risk factors and postoperative liver dysfunction was established. Results Among the 62 patients, ICG R15 was less than 10.0% in 26 patients, between 10.0% and 19.0% in 17 patients, between 20.0% and 29.0% in 9 patients, between 30.0% and 39.0% in 5 patients, and over 40.0% in 5 patients. There were 29 patients with a Child-Pugh A grading and 33 patients with a Child-Pugh B grading in the preoperative evaluation of liver function. The Wilcoxon W rank sum test was used to compare the preoperative ICG R15 in patients with Child-Pugh grading A and B separately. The ICG R15 in Child-Pugh grading A patients was significantly lower than those in Child-Pugh B grading patients (P 0.05) between the normal liver function group and the liver dysfunction group. However, there was a significant difference in the preoperative ICG R15 and preoperative bilirubin levels (P<0.05) between the two groups. The preoperative ICG R15 and preoperative bilirubin levels were significant risk factors of postoperative hepatic insufficiency. Regression analysis suggested that preoperative ICG R15 level was an independent risk factor of postoperative hepatic insufficiency (P<0.05). A regression equation: logit(P)=0.185×preoperative ICG R15-3.152 could be constructed. Conclusions ICG R15 is an ideal clinical indicator for evaluation of preoperative liver functional reserve in patients with HCCA. It predicted the recovery of postoperative liver function. Key words: Bile duct neoplasms; Hepatic insufficiency; Hilar cholangiocarcinoma; Indocyanine green