Assessment of liver function for successful hepatectomy in patients with hepatocellular carcinoma with impaired hepatic function.
OBJECTIVE
This study aimed to construct a formula for assessing liver function in order to prevent post-hepatectomy liver failure.


METHODS
A formula was constructed by analyzing data from 28 patients with hepatocellular carcinoma (HCC) with liver cirrhosis operated on between 1981 and 1984. Next, we evaluated the validity of this formula in 207 hepatectomy patients operated on from 1985 to 1999. For 145 hepatectomy patients operated on from 2000 to 2006, this formula was calculated before surgery in order to assess their risk of hepatectomy.


RESULTS
The formula for liver functional evaluation, constructed from preoperative hepatic function parameters, was: liver failure score = 164.8 - 0.58 x Alb - 1.07 x HPT + 0.062 x GOT - 685 x K. ICG - 3.57 x OGTT. LI + 0.074 x RW, where Alb is albumin (g/dl); HPT, hepaplastin test (%); GOT, glutamate oxaloacetate transaminase (U/l); K. ICG, K value of indocyanine green clearance test; OGTT. LI, 60-min/120-min glucose level in 75-g oral glucose tolerance test. linearity index of OGTT; and RW, weight of resected liver (g). We decided that a score below 25 would be safe for hepatectomy.


CONCLUSIONS
The mortality rate decreased from 3.9% in 1985--1999 to 1.3% in 2000--2006. This finding allows us to conclude that the formula is valid for assessing the risk of post-hepatectomy liver failure.
Uchiyama
Kazuhisa
K
Second Department of Surgery, Wakayama Medical University, School of Medicine, 811-1 Kimiidera, Wakayama, 641-8510, Japan.
Mori
Kazunari
K
Tabuse
Katsuyoshi
K
Ueno
Masaki
M
Ozawa
Satoru
S
Nakase
Takayuki
T
Kawai
Manabu
M
Tani
Masaji
M
Tanimura
Hiroshi
H
Yamaue
Hiroki
H
D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000503:physiopathology* / Q000601:surgery*; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D016014:Linear Models; D008103:Liver Cirrhosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000401:mortality / Q000503:physiopathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged