Perioperative noninvasive indocyanine green testing to predict outcomes after major liver resections

• Grant number: 17/00828-0
• Support Opportunities: Regular Research Grants
• Duration: February 01, 2018 - July 31, 2020
• Field of knowledge: Health Sciences - Medicine - Surgery
• Principal Investigator: Fabricio Ferreira Coelho
• Grantee: Fabricio Ferreira Coelho
• Host Institution: Hospital das Clínicas da Faculdade de Medicina da USP (HCFMUSP). Secretaria da Saúde (São Paulo - Estado). São Paulo , SP, Brazil
• Associated researchers: Gilton Marques Fonseca ; Jaime Arthur Pirola Kruger ; Paulo Herman ; Vagner Birk Jeismann

Abstract

Postoperative liver failure (PLF) is a serious complication after major liver resections (e 3 segments), especially in patients with impaired liver function due to prolonged chemotherapy, cholestasis and cirrhosis. For this reason, a correct estimation of hepatic functional reserve is essential to prevent PLF. Data from Eastern centers indicate that indocyanine green (ICG) elimination is a useful predictor of perioperative morbidity in patients submitted to major hepatectomies. However there was a lack of data from Western centers. ICG retention rate at 15 min (ICGR15) and ICG plasma disappearance rate (ICGPDR) are the most commonly parameters assessed. We proposed a prospective perioperative noninvasive ICG testing (ICGR15 and ICGPDR) protocol in 45 patients candidates to major liver resections. Subgroup analysis will be done for patients with liver dysfunction: patients with colorectal liver metastases undergoing prolonged chemotherapy (> 6 cycles), hepatocellular carcinoma in patients with cirrhosis (Child-Pugh A and B) and patients with prolonged cholestasis (> 10 days). ICG measurements will be performed preoperatively, after surgery, and from POD1 to POD5. The primary end-point is to identify a cut-off of preoperative ICGR15 and ICGPDR able to predict early postoperative complications, PLF and mortality. The secondary end-point is to assess if the postoperative sequential changes in ICGR15 and ICGPDR correlate with laboratory tests and can predict postoperative complications, PLF and mortality. (AU)