Two-Staged Procedure of Portal Ligation and Hepatectomy Monitored by ICG Clearance

Background: The aim of the study was to predict and estimate the optimal time of resection following portal vein ligation (PVL) with the aid of three dimensional (3D) computed tomography (CT) volumetry and indocyanine green (ICG) clearance in healthy liver. Following right PVL, we induced hypertrophy of the left liver lobe prior to an extended right hepatectomy. Methods: Fourteen patients with right lobe liver metastases from colorectal cancer underwent right PVL. Cutoff points for the ICG clearance test were: R15 < 14% or PDR > 15%/min. The criteria for resection also required a remnant liver volume of 25% of the whole liver volume. The latter was assessed by CT scan prior to the procedures. Liver function was measured with routine biochemical tests and ICG clearance. Postoperatively, repeated ICG clearance and 3D CT volumetry tests were used to estimate the liver's regeneration. Liver resections were performed as a second stage. Results: After portal ligation, ICG clearance increased significantly in some patients, while in others, the ICG clearance remained unchanged with borderline low or normal clearance values. Between the two operations, patients with high clearance had less complications and a better regeneration rate of the left lobe with a shorter waiting period in contrast to the “low ICG group.” Conclusions: ICG clearance has a significant prognostic value. Patients with an apparently inoperable right lobe liver tumor can be successfully treated using a two-staged procedure of portal vain ligation followed by hepatectomy. The 3D CT volumetry and ICG clearance test are essential monitoring tools in these liver resections.