The feasibility of Makuuchi criterion for resection of hepatocellular carcinoma.
OBJECTIVE
The Makuuchi criterion was proposed to select for the appropriate hepatectomy in an impaired liver. However, there are no comparative analyses concerning this criterion. Our purpose is to evaluate the efficacy of it.


METHODS
We conducted our study on 471 patients with hepatocellular carcinoma, resected from January 1986 to April 2004. We defined surgery consistent with Makuuchi criterion as group 1, and other as group 2. We performed comparative analysis of surgical results.


RESULTS
Group 1 showed lower intraoperative blood loss (1602 +/- 119 mL vs. 2448 +/- 244mL: P = 0.002), mortality (4.4% vs. 12.5%: P = 0.009), and postoperative serum total bilirubin (3.4 +/- 0.2 mg/dL vs. 6.2 +/- 0.8 mg/ dL: P < 0.0001) than group 2. Five-year survival rates were not significantly different between group 1 (43%) and 2 (35%): P = 0.18. Blood loss in operative deaths was greater than in survivors, both in group 1 (6155 +/- 1725 mL vs. 1391 +/- 83 mL: P < 0.0001) and in group 2 (4381 +/- 946 mL vs. 2172 +/- 231mL: P = 0.002). Blood loss in patients with postoperative liver failure was also greater than in others, both in group 1 (2692 +/- 292 mL vs. 1146 +/- 106 mL: P < 0.0002) and in group 2 (2968 +/- 335 mL vs. 1538 +/- 265 mL: P = 0.004).


CONCLUSIONS
Our study showed Makuuchi criterion is helpful for a safe hepatectomy for hepatocellular carcinoma. If inconsistent with it, 2172 mL and 1538 mL blood loss are considered permissible upper limits to avoid operative death and liver failure, respectively.
Kure
Shigehiro
S
Department of Surgery II, Nagoya University, Graduate School of Medicine, Nagoya, Japan.
Kaneko
Tetsuya
T
Takeda
Shin
S
Inoue
Soichiro
S
Nakao
Akimasa
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000601:surgery*; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies