Functional anatomical hepatectomy guided by indocyanine green fluorescence imaging in patients with localized cholestasis:Report of four cases

BACKGROUND Liver cancer is a malignant tumor with a high incidence.At present,the most effective treatment is laparoscopic hepatectomy(LH).Indocyanine green fluorescence imaging(ICG-FI)has become an important tool in LH,and the most common fluorescent types of tumors are total fluorescence,partial fluorescence,and rim fluorescence.CASE SUMMARY We presented four cases of LH guided by ICG-FI in which we also observed the fourth special fluorescent type.When the tumor or intrahepatic stone compresses the adjacent bile duct to cause local cholestasis,the liver segment or subsegment with obstructed bile drainage will show strong fluorescence.Complete removal of the lesion together with the fluorescent liver parenchyma may help reduce the risk of tumor or stone recurrence.CONCLUSION This type of partial fluorescence can indicate local biliary compression,and the resection method is related to bile drainage,which may be called functional anatomical hepatectomy and ensures radical resection of the lesion.

Advances in preoperative assessment of liver function

BACKGROUND： Postoperative liver failure remains a lifethreatening complication. Preoperative evaluation of liver function is essential in reducing the complications after hepatectomy. However, it is difficult to accurately evaluate liver function before surgery because of the limitations of the liver function tests available. Recent advances in liver function tests improved the ability to assess liver function. The present review was to analyze these methods and their advantages.DATA SOURCES： MEDLINE was searched using the terms of ＂liver function test＂, ＂liver function evaluation＂ and ＂galactosyl serum albumin＂. Relevant articles published in English and Chinese from 1961 to 2014 were reviewed.RESULTS： Although serological tests are used frequently in practice, they reflect the degree of total liver damage or function, not the remnant of liver function. Child-Pugh score and model for end-stage liver disease（MELD） score assess whole liver function, and are particularly useful in determining whether patients with hepatocellular carcinoma and cirrhosis are candidates for resection or transplantation, but cannot determine the safe extent or removal. The indocyanine green and other metabolic quantitative liver function tests can evaluate functional hepatocytes, making them more accurate in predicting liver function. Computed tomography（CT）volumetry can provide anatomic information on the remnant liver volume but not on functional volume. 99mTc-galactosyl serum albumin scintigraphy, combined with single photon emission computed tomography, CT and three-dimensional reconstruction, may be a better quantitative measure of liver function, especially of remnant liver function.CONCLUSIONS： Tests used to evaluate liver functional reserve and to predict surgical risk have limitations. 99mTc-galactosylserum albumin scintigraphy, which can more accurately evaluate the whole and regional liver function, may be promising in predicting resection margins and risks of liver failure.