Evaluation of preoperative hepatic function in patients with hepatocellular carcinoma undergoing hepatectomy

Lau, Hung; Man, Kwan; Fan, Sheung‐Tat; Yu, Wun-Ching; Lo, Chung‐Mau; Wong, John

doi:10.1002/bjs.1800840917

Cited by 270 publications

(138 citation statements)

References 20 publications

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“…However, the optimal ICGR 15 value for a safe major hepatectomy is different in different series [22,23,24]. Moreover, the ICG clearance test did not reach a significant level as a predictor in some previous reports [12,13]or in the current study.…”

Section: Discussioncontrasting

confidence: 44%

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A New Prediction Model of Postoperative Complications after Major Hepatectomy for Hepatocellular Carcinoma

et al. 2009

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Background/Aims: Serum hyaluronic acid (HA) concentrations reflect the degree of hepatic dysfunction and may have potential for predicting postoperative complications in a major hepatectomy for hepatocellular carcinoma (HCC). Methods: Serum HA concentrations and other conventional liver function tests were measured prior to major hepatectomies in 52 patients. Independent predictors for postoperative complications were analyzed and the discriminant equation was established and validated. Results: Postoperative complications occurred in 17 patients. Serum HA concentrations and the estimated remnant liver volume ratio (remnantVol%) were recognized as independent predictors for postoperative complications (OR 1.03, 0.85; CI 95% 1.01–1.06, 0.76–0.95; p = 0.006, 0.006; respectively) and produced the discriminant equation: logit = 4.15 + 0.03 × (HA) –0.16 × (remnantVol%). The value of the area under the curve of a receiver operating characteristic analysis was 0.92. If the cut-off of the logit value was set to 0, then the predictive accuracy was 0.88. The validation accuracy performed by a leave-one-out cross-validation method was 0.83. Conclusions: The constructed discriminant equation model consisting of the preoperative serum HA concentrations and estimated remnantVol% could be useful for predicting postoperative complications in a major hepatectomy for HCC.

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Section: Discussioncontrasting

confidence: 44%

“…The ICG clearance test has been recognized, generally,as one of the most discriminatory measures for selecting patients for a hepatectomy and has been included in various algorithms of surgical procedure selection [5,6,22]. However, the optimal ICGR 15 value for a safe major hepatectomy is different in different series [22,23,24].…”

Section: Discussionmentioning

confidence: 99%

A New Prediction Model of Postoperative Complications after Major Hepatectomy for Hepatocellular Carcinoma

et al. 2009

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“…28 -30 In our center, we routinely perform the ICG clearance test for all patients undergoing hepatic resection as we have demonstrated in a multivariate analysis that out of many liver function tests, ICG clearance was the single best test in predicting hospital mortality after major hepatectomy for HCC. 29 Based on our experience of hepatectomy for HCC in the early 1990s, ICG retention at 15 minutes of less than 14% was identified as the safety limit for major hepatic resection, which was defined as resection of 3 or more segments of liver. 31 However, with improved surgical techniques and perioperative care, we found that the limit could be expanded.…”

Section: Assessment Of Liver Function Reservementioning

confidence: 99%

Hepatectomy for hepatocellular carcinoma: Patient selection and postoperative outcome

2004

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Hepatic resection and liver transplantation are considered the only curative treatments for hepatocellular carcinoma (HCC). Liver transplantation for HCCs < or =5 cm in diameter has been shown to produce favorable survival results, but its application is limited by the lack of donors. Hepatic resection remains the treatment of choice for patients who are not transplantation candidates because of large tumor, macroscopic vascular invasion, or advanced age. For small HCCs associated with Child's A cirrhosis, hepatic resection should still be considered the first-line treatment, but salvage transplantation for intrahepatic recurrence may be a feasible strategy. Recent improvement in surgical techniques and perioperative care has increased the safety and expanded the indication of hepatic resection for HCC to include large tumors that require extended hepatectomy in cirrhotic patients. Selection of appropriate candidates for hepatectomy depends on careful assessment of the tumor status and liver function reserve. Evaluation of the general fitness of patients is also critical because comorbid illness is an important cause of postoperative mortality, even if the patients have good liver function reserve. With careful patient selection and surgical expertise, the current operative mortality of hepatectomy for HCC is about 5% or less in major centers. Improved long-term survival results after resection of HCC have also been reported recently, with an overall 5-year survival rate of about 50%. The improved perioperative and long-term survival results have strengthened the role of hepatectomy as the mainstay of treatment for HCC despite the availability of a number of other treatment options for localized HCC.

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“…Fan et al [48] reported that 101 patients underwent major hepatic resection with a mortality of 13.8%; an ICG R15 value of 14% was the cutoff point for patient short-term survival according to discriminant analysis. Lau et al [94] reported a mortality of 11% in 127 patients submitted to liver resection. In their study, ICG R15 was the only test that could discriminate between survivors and non-survivors.…”

Section: Limits For Safe Liver Resectionmentioning

confidence: 99%

How Much Remnant Is Enough in Liver Resection?

Guglielmi¹,

Ruzzenente²,

Conci³

et al. 2012

Dig Surg

283

204

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Background: Liver resection represents the first choice of treatment for primary and secondary liver malignancies, offering the patient the best chance of long-term survival. The extensive use of major hepatectomy increases the risk of post-hepatectomy liver failure (PHLF), which is associated with a high frequency of postoperative complications, mortality and increased length of hospital stay. Aims: The aim of this review is to investigate the different risk factors related to the occurrence of PHLF and to identify the limits for a safe liver resection in patients with normal liver and injured liver (cirrhosis, cholestasis, steatosis and post-chemotherapy liver injury). Methods: A literature search was undertaken in PubMed and related search engines, looking for articles relating to hepatic failure following hepatectomy in normal liver or injured liver. Results: In spite of improvements in surgical and postoperative management, the parameters determining how much liver can be resected are still largely undefined. A number of preoperative, intraoperative and postoperative factors all contribute to the likelihood of liver failure after surgery. The safe limits for liver resection can be estimated from the data of the literature for patients with normal liver and for those with different types of liver injury. Conclusions: Preoperative assessment that includes evaluation of liver volume and function of the remnant liver is a mandatory prerequisite before major hepatectomy. The critical residual liver volume for patients able to predict PHLF is mainly related to the presence of pre-existing liver disease and liver function. Among patients with normal liver, the limit for safe resection ranges from 20 to 30% future remnant liver of total liver volume. In patients with injured liver (cirrhosis, cholestasis or steatosis), preoperative assessment of the risk of PHLF should include future remnant liver volumetry and accurate liver function evaluation, including different dynamic liver function tests.

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Evaluation of preoperative hepatic function in patients with hepatocellular carcinoma undergoing hepatectomy

Abstract: The ICG clearance test, expressed as the percentage of ICG retained at 15 min, is the best discriminating preoperative test for evaluating hepatic functional reserve in patients with HCC before hepatectomy.

Cited by 270 publications

References 20 publications

A New Prediction Model of Postoperative Complications after Major Hepatectomy for Hepatocellular Carcinoma

A New Prediction Model of Postoperative Complications after Major Hepatectomy for Hepatocellular Carcinoma

Hepatectomy for hepatocellular carcinoma: Patient selection and postoperative outcome

How Much Remnant Is Enough in Liver Resection?

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