title: Low preoperative platelet counts predict a high mortality after partial hepatectomy in patients with hepatocellular carcinoma.
abstract: OBJECTIVE
  To assess the validity of our selection criteria for hepatectomy procedures based on indocyanine green disappearance rate (K(ICG)), and to unveil the factors affecting posthepatectomy mortality in patients with hepatocellular carcinoma (HCC).
  
  
  METHODS
  A retrospective analysis of 198 consecutive patients with HCC who underwent partial hepatectomies in the past 14 years was conducted. The selection criteria for hepatectomy procedures during the study period were K(ICG)>or=0.12 for hemihepatectomy, K(ICG)>or=0.10 for bisegmentectomy, K(ICG)>or=0.08 for monosegmentectomy, and K(ICG)>or=0.06 for nonanatomic hepatectomy. The hepatectomies were categorized into three types: major hepatectomy (hemihepatectomy or a more extensive procedure), bisegmentectomy, and limited hepatectomy. Univariate (Fisher's exact test) and multivariate (the logistic regression model) analyses were used.
  
  
  RESULTS
  Postoperative mortality was 5% after major hepatectomy, 3% after bisegmentectomy, and 3% after limited hepatectomy. The three percentages were comparable (P = 0.876). The platelet count of <or=10X10(4)/microL was the strongest independent factor for postoperative mortality on univariate (P = 0.001) and multivariate (risk ratio, 12.5; P = 0.029) analyses. No patient with a platelet count of >7.3X10(4)/microL died of postoperative morbidity, whereas 25% (6/24 patients) of patients with a platelet count of <or=7.3X10(4)/microL died (P<0.001).
  
  
  CONCLUSIONS
  The selection criteria for hepatectomy procedures based on K(ICG) are generally considered valid, because of the acceptable morbidity and mortality with these criteria. The preoperative platelet count independently affects morbidity and mortality after hepatectomy, suggesting that a combination of K(ICG) and platelet count would further reduce postoperative mortality.
authors.affiliation: Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Kaneko
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Shirai
authors.forename: Toshifumi
authors.initials: T
authors.lastname: Wakai
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Yokoyama
authors.forename: Kohei
authors.initials: K
authors.lastname: Akazawa
authors.forename: Katsuyoshi
authors.initials: K
authors.lastname: Hatakeyama
mesh_terms: D016063:Blood Loss, Surgical; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D004396:Coloring Agents / Q000378:metabolism; D006498:Hepatectomy / Q000401:mortality*; D006801:Humans; D007208:Indocyanine Green / Q000378:metabolism; D008113:Liver Neoplasms / Q000601:surgery*; D018579:Patient Selection; D010976:Platelet Count; D011182:Postoperative Care; D011300:Preoperative Care; D015203:Reproducibility of Results; D012307:Risk Factors; D015996:Survival Rate
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green