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

Grant number: 17/00828-0
Support type:Regular Research Grants
Duration: February 01, 2018 - July 31, 2020
Field of knowledge:Health Sciences - Medicine - Surgery
Principal researcher:Fabricio Ferreira Coelho
Grantee:Fabricio Ferreira Coelho
Home Institution: Hospital das Clínicas da Faculdade de Medicina da USP (HCFMUSP). Secretaria da Saúde (São Paulo - Estado). São Paulo , SP, Brazil
Assoc. 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)

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