Title: Comparative Study of Indocyanine Green (ICG)-R15 and Albumin-Indocyanine Green
Evaluation (ALICE) Grading System in the Prediction of Posthepatectomy Liver Failure and
Postoperative Mortality in Patients with Hepatic Alveolar Echinococcosis
Version: 3 Date: 14 May 2022
Reviewer:  Po-chih Yang
Reviewer's report:
In this manuscript, ICG-R15 and ALICE grading system were evaluated retrospectively for their
ability to predict posthepatectomy liver failure (PHLF). My feedback was listed as below.
1. For ICG-R15 measurement, pulse dye density graph analyzer was used in this study instead of
traditionally sequential blood test. Could you show reference about the accuracy of this method
compared with traditional blood draw?
2. Operation related mortality is usually defined as mortality within 90 days after operation. But
in this study, mortality after 12 months was analyzed. By this definition, mortality could not be
related to hepatectomy. Could you explain about this?
3. ICG-R15 and ALICE grading system have been both recognized as good measurement for
liver function. However, besides liver function, the extent of liver resection is a very important
factor to predict PHLF. The extent of liver resection should be integrated into preoperative
evaluation together with liver function test. In this study, the extent of hepatectomy was only
divided into two category, resection less than 3 segments or not and only showed in Table 1
basic characteristics. Patients with good liver function could also develop PHLF after extremely
large extent of hepatectomy and vice versa. I recommend authors to integrate the extent of liver
resection with percentage of liver volume in the analysis to reflect the true value of these liver
function measurement.
4. The result showed the cut-off value of ICG-R15 to predict PHLF is 7.2%. But, the value of
ICG-R15 in common people is about 10~13%. 7.2% is relatively good result of ICG-R15. Is
this result meaningful for clinical use or just the result of statistics?
5. In Figure 5, there are recommendation of extent of hepatectomy according to different Child-
Pugh grade and ALICE grade. Could you show the basis for this recommendation of resected
segment numbers because there was not any comparison of resection extent in this study?
Title: Comparative Study of Indocyanine Green (ICG)-R15 and Albumin-Indocyanine Green
Evaluation (ALICE) Grading System in the Prediction of Posthepatectomy Liver Failure and
Postoperative Mortality in Patients with Hepatic Alveolar Echinococcosis
Version: 3 Date: 14 May 2022
Reviewer:  Po-chih Yang
Reviewer's report:
In this manuscript, ICG-R15 and ALICE grading system were evaluated retrospectively for their
ability to predict posthepatectomy liver failure (PHLF). My feedback was listed as below.
1. For ICG-R15 measurement, pulse dye density graph analyzer was used in this study instead of
traditionally sequential blood test. Could you show reference about the accuracy of this method
compared with traditional blood draw?
2. Operation related mortality is usually defined as mortality within 90 days after operation. But
in this study, mortality after 12 months was analyzed. By this definition, mortality could not be
related to hepatectomy. Could you explain about this?
3. ICG-R15 and ALICE grading system have been both recognized as good measurement for
liver function. However, besides liver function, the extent of liver resection is a very important
factor to predict PHLF. The extent of liver resection should be integrated into preoperative
evaluation together with liver function test. In this study, the extent of hepatectomy was only
divided into two category, resection less than 3 segments or not and only showed in Table 1
basic characteristics. Patients with good liver function could also develop PHLF after extremely
large extent of hepatectomy and vice versa. I recommend authors to integrate the extent of liver
resection with percentage of liver volume in the analysis to reflect the true value of these liver
function measurement.
4. The result showed the cut-off value of ICG-R15 to predict PHLF is 7.2%. But, the value of
ICG-R15 in common people is about 10~13%. 7.2% is relatively good result of ICG-R15. Is
this result meaningful for clinical use or just the result of statistics?
5. In Figure 5, there are recommendation of extent of hepatectomy according to different Child-
Pugh grade and ALICE grade. Could you show the basis for this recommendation of resected
segment numbers because there was not any comparison of resection extent in this study?
Please review this paper.
user
Title: Comparative Study of Indocyanine Green (ICG)-R15 and Albumin-Indocyanine Green
Evaluation (ALICE) Grading System in the Prediction of Posthepatectomy Liver Failure and
Postoperative Mortality in Patients with Hepatic Alveolar Echinococcosis
Version: 3 Date: 14 May 2022
Reviewer:  Po-chih Yang
Reviewer's report:
In this manuscript, ICG-R15 and ALICE grading system were evaluated retrospectively for their
ability to predict posthepatectomy liver failure (PHLF). My feedback was listed as below.
1. For ICG-R15 measurement, pulse dye density graph analyzer was used in this study instead of
traditionally sequential blood test. Could you show reference about the accuracy of this method
compared with traditional blood draw?
2. Operation related mortality is usually defined as mortality within 90 days after operation. But
in this study, mortality after 12 months was analyzed. By this definition, mortality could not be
related to hepatectomy. Could you explain about this?
3. ICG-R15 and ALICE grading system have been both recognized as good measurement for
liver function. However, besides liver function, the extent of liver resection is a very important
factor to predict PHLF. The extent of liver resection should be integrated into preoperative
evaluation together with liver function test. In this study, the extent of hepatectomy was only
divided into two category, resection less than 3 segments or not and only showed in Table 1
basic characteristics. Patients with good liver function could also develop PHLF after extremely
large extent of hepatectomy and vice versa. I recommend authors to integrate the extent of liver
resection with percentage of liver volume in the analysis to reflect the true value of these liver
function measurement.
4. The result showed the cut-off value of ICG-R15 to predict PHLF is 7.2%. But, the value of
ICG-R15 in common people is about 10~13%. 7.2% is relatively good result of ICG-R15. Is
this result meaningful for clinical use or just the result of statistics?
5. In Figure 5, there are recommendation of extent of hepatectomy according to different Child-
Pugh grade and ALICE grade. Could you show the basis for this recommendation of resected
segment numbers because there was not any comparison of resection extent in this study?
assistant