Evaluation of liver function for hepatic resection for hepatocellular carcinoma in the liver with damaged parenchyma.
BACKGROUND
Liver functional parameters, including the Child-Pugh score and indocyanine green clearance (ICG), and volumetric parameters influencing postoperative liver function were evaluated with the aim of obtaining standardardized criteria for selecting patients for, and deciding the extent of, hepatectomy for hepatocellular carcinoma (HCC).


METHODS
The study population consisted of 120 patients with HCC undergoing hepatic resection excluding those with more than 3000 ml of intraoperative bleeding. Patients were classified as grades A, B, or C on the basis of, respectively, a Child-Pugh score of 5 or 6, 7-9, or >or=10 and were assigned to group D (postoperative liver dysfunction) or group N (no complication). Postoperative complications included massive ascites, pleural effusion, or hyperbilirubinemia. For each grade, the standardized estimated liver remnant ratio (STELR) was determined as the ratio of the liver remnant volume (estimated by computerized tomography) to the standardized total liver volume (STLV), estimated from the body surface area using the equation: liver volume [cm(3)] = 706 x body surface area [m(2)] + 2.4. The ICG retention rate at 15 min after injection (ICGR15) was then plotted against the STELR for each grade and a demarcation line separating patients in groups N and D was determined statistically by discriminant analysis.


RESULTS
For grade A patients, the equation of the demarcation line was ICGR15 = 27.5 x STELR + 1.9 (Wilks' Lambda: 0.667, P < 0.001), indicating that, for safe hepatic resection in patients with an ICGR15 of 10%, the STELR should be greater than 0.29. In contrast, for grade B patients, the equation was ICGR15 = 72 x STELR - 22.1 (0.589, P < 0.001), indicating that, in patients with a 10% ICGR15, the STELR should be greater than 0.44, a larger value than in grade A patients. The number of grade C patients was too small for analysis.


CONCLUSIONS
By combining the Child-Pugh score, ICG clearance, and liver volumetric parameters, criteria for the selection of patients for hepatic resection for HCC were established.
Wakabayashi
Hisao
H
Department of Surgery, Sakaide Municipal General Hospital, Sakaide-city, Kagawa, Japan. hisao-w@mxi.netwave.or.jp
Ishimura
Ken
K
Izuishi
Kunihiko
K
Karasawa
Yukihiko
Y
Maeta
Hajime
H
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000503:physiopathology* / Q000601:surgery*; D016002:Discriminant Analysis; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects; D006801:Humans; D007208:Indocyanine Green / Q000493:pharmacokinetics; D008099:Liver / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery*; D008113:Liver Neoplasms / Q000503:physiopathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D014057:Tomography, X-Ray Computed
D007208:Indocyanine Green