Clinical Study
Assessment of Liver Remnant Using ICG Clearance Intraoperatively during Vascular Exclusion: Early Experience with the ALIIVE Technique
Table 1
Demographic, preoperative/operative factors and ICG clearance stratified by outcome.
| | Demographics | Median (% or range) |
Dead | Alive | Posthepatectomy liver failure | No posthepatectomy liver failure |
| | Number | 10 | 1 | 9 | 3 | 7 | | Sex (male : female) | 8 : 2 | male | 7 : 2 | 3 male | 5 : 2 | | Age | 60.9 (19–76) | 75 | 63.7 ± 11.8 | 70.8 ± 4.5 | 62.5 ± 13.0 | | BMI | 23.4 (21–30) | 22.8 | 25 ± 3.2 | 25.2 ± 3.1 | 24.8 ± 3.3 |
| | Preoperative factors | | | | | | | Colorectal metastases | 6 | 0 | 6 | 0 | 6 | | Cholangiocarcinoma | 4 | 1 | 3 | 3 | 1 | | Preoperative chemotherapy | 7 | 0 | 7 | 1 | 6 | | Portal vein embolisation | 5 | 1 | 4 | 2 | 3 | |
If PVE-kinetic growth rate (%/week) | 7.4 (6.47–9.07) | 6.6 | 7.38 ± 1.2 | 7.0 ± 0.6 | 7.8 ± 1.8 | | Trisegmentectomy | 6 | 1 | 5 | 1 | 5 | | Right hemihepatectomy | 3 | 0 | 3 | 2 | 1 | | Left hemihepatectomy | 1 | 0 | 1 | 0 | 1 | | Future liver remnant volume (mL) | 760 (351–1221) | 710 | 877 ± 299 | 869 ± 196 | 859 ± 328 | | CT volumetry (%) | 46 (26–84) | 38 | 53 ± 18 | 43.0 ± 4.4 | 54.5 ± 19.9 | | Standardized volumetry (%) | 57 (22–66) | 49 | 55 ± 17 | 57.9 ± 8.3 | 53.3 ± 19.0 | | Bilirubin (μmol/L) | 12 (5–35) | 25 | 13 ± 10 | 10 ± 5.4 | 23 ± 13.1 |
| | Operative factors | | | | | | | Blood loss (mL) | 650 (200–1500) | 1200 | 660 ± 568 | 700 ± 707 | 775 ± 585 | | Operating time (min) | 510 (360–840) | 540 | 518 ± 165 | 500 ± 69 | 534 ± 195 |
| | ICG clearance | | | | | | | ICG 1: preoperative | 21.4 (12.2–25.5) | 14.2 | 19.2 ± 5.2 | 24.2 ± 1.9 | 17.8 ± 5.0 | | ICG 2: under anaesthesia ± clearance of future liver remnant | 15.2 (7.0–28.3) | 11.7 | 18.0 ± 7.7 | 19.7 ± 7.6 | 15.7 ± 7.8 | | ICG 3: inflow control | 11.0 (7.3–16.2) | 7.5 | 11.8 ± 3.0 | 8.6 ± 2.1 | 12.9 ± 2.7 | | ICG 4: inflow control following parenchymal transection | 10.3 (7.8–13.8) | 7.8 | 10.7 ± 2.1 | 10.4 ± 3.8 | 10.7 ± 2.3 | | ICG 5: inflow and outflow control following parenchymal transection (ALIIVE) | 12.9 (7.1–24.7) | 7.1 | 14.4 ± 4.9 | 10.4 ± 4.2 | 15.2 ± 5.1 | | | | | | | | | Cardiac index (ICG2) | 2.4 (2.1–3.3) | 2.1 | 2.6 ± 0.5 | 2.1 ± 0.1 | 3.0 ± 0.4 | | Cardiac index (ICG3) | 2.8 (1.9–3.2) | 2.6 | 2.7 ± 0.5 | 2.3 ± 0.4 | 3.1 ± 0.2 | | Cardiac index (ICG4) | 3.0 (2.3–3.2) | 3.0 | 2.8 ± 0.5 | 2.7 ± 0.5 | 3.2 ± 0.5 | | Cardiac index (ICG5) | 3.0 (2.4–3.6) | 3.1 | 2.9 ± 0.5 | 2.8 ± 0.4 | 3.4 ± 0.5 |
| | Outcome | | | | | | | Hospital stay (days) | 11 days (5–48) | n/a | 16 ± 14 | 33 ± 21 | 10 ± 4 | | Posthepatectomy liver failure | 3 (30%) | | | | | | Grade A: abnormal lab parameters | 1 (10%) | | | | | | Grade B: deviation from routine clinical management without invasive treatment | 1 (10%) | | | | | | Grade C: deviation from routine clinical management requiring invasive treatment | 1 (10%) | | | | |
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