Assessment of Preoperative Liver Function for Surgical Decision Making in Patients with Hepatocellular Carcinoma

Abstract

<b><i>Background:</i></b> Most patients with hepatocellular carcinoma (HCC) have underlying liver disease and a preoperative liver function evaluation is important to avoid postoperative liver failure and death. In Western guidelines, portal hypertension (PH) is listed as a contraindication for liver resection. On the other hand, the indocyanine green retention rate at 15 min (ICG R15) has been widely used in Asian countries for surgical decision making. However, these criteria are based on reports published in the 20th century that included only a small number of patients and were developed empirically. <b><i>Summary:</i></b> The number of published case series concerning liver resection in HCC patients with PH has been rapidly increasing since 2011, indicating that liver resection in HCC patients with PH is now routinely performed in specialized centers worldwide. Although PH certainly has an impact and should be considered as a contraindication for major liver resection, it is no longer considered to be a contraindication for minor liver resection, especially laparoscopic liver resection. In addition, new biomarkers and imaging tools to assess preoperative liver function have been extensively reported. The combination of these new factors to well-known risk factors, such as PH and ICG R15, might strengthen the ability to stratify the risk of postoperative liver failure. <b><i>Key Messages:</i></b> The present review covers recent topics regarding the assessment of preoperative liver function for surgical decision making in patients with HCC.

Role and Mechanism of Rhizopus Nigrum Polysaccharide EPS1-1 as Pharmaceutical for Therapy of Hepatocellular Carcinoma

“…In recent years, there has been increasing attention on the natural antitumor compounds due to their biological activities and little or no side effects (Zhang et al, 2018;Kokudo et al, 2019;Li et al, 2019). Rhizopus nigrum is a zygote filamentous fungus that has been widely used in the brewing and pharmaceutical industries due to its biocatalytic and bio-transformative functions (Pan et al, 2019).…”

Surgical strategies for hepatocellular carcinoma located in the left lateral lobe: A propensity score‐matched and prognostic nomogram study

“…It is worth noting that all patients in the two groups had good liver function (Child‐Pugh grade A) after PSM. Therefore, HCC patients with sufficient liver reserve may obtain a survival benefit after undergoing LH without an increased incidence of postoperative complications 22,23 . However, it remains unclear whether the occurrence of postoperative complications will increase in patients with Child‐Pugh grade B after LH.…”

Comment on “Outcomes of curative liver resection for hepatocellular carcinoma in patients with cirrhosis”

“…Hence, it supplies the required standards to prevent surgical trauma, blood loss through the liver, and other complications associated with acute liver failure. Recently, Kokudo et al [ 3 ] reported that ICG-R15 might improve the clinicians' capability to stratify patients at risk for surgical liver failure. Likewise, in a comparative analysis of 185 patients, Wang et al [ 4 ] found that the ICG-R15 is more reliable than the MELD score and the Child-Pugh score in indicating hepatic functional reserve before hepatectomy.…”