Prediction of the risk of hepatic failure in patients with portal vein invasion hepatoma after hepatic resection.
OBJECTIVE
Hepatic failure can develop after curative hepatectomy in patients with a hepatocellular carcinoma (HCC) invading the portal vein, because of cirrhosis and excessive tissue loss. This study aimed to identify the risk factors for hepatic failure in such patients.


METHODS
Forty patients with an HCC invading the portal vein underwent curative hepatectomy from January 1995 to June 2003. Eight patients developed hepatic failure and died within 3 months. Possible risk factors for this were analysed using univariate and multivariate regression. These included the liver function index, surgical blood loss, tumour pattern, portal hypertension, estimated residual liver volume measured by computed tomography (ERLV(CT)) and estimated residual liver volume using the indocyanine green (ICG) retention rate at 15 min (ERLV(ICG15)).


RESULTS
The ERLV(CT) smaller than the ERLV(ICG15) and presence of portal hypertension were independent risk factors for post-hepatectomy hepatic failure.


CONCLUSIONS
Having portal vein invasion HCC with portal hypertension or an ERLV(CT) less than an ERLV(ICG15) are significant predictors of post-hepatectomy hepatic failure. These factors are important considerations for patients with portal vein invasion HCC who could undergo curative hepatic resection.
Hsieh
C B
CB
Department of Surgery, National Defense Medical Center, Tri-Service General Hospital, No. 325, Sec 2 Cheng-Kung Road, Neihu 114, Taipei, Taiwan, ROC.
Yu
C Y
CY
Tzao
C
C
Chu
H C
HC
Chen
T W
TW
Hsieh
H F
HF
Liu
Y C
YC
Yu
J C
JC
D006528:Carcinoma, Hepatocellular / Q000473:pathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000009:adverse effects*; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications; D017093:Liver Failure / Q000000981:diagnostic imaging / Q000209:etiology* / Q000401:mortality; D008113:Liver Neoplasms / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D011169:Portal Vein / Q000000981:diagnostic imaging / Q000473:pathology*; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome