Liver functional reserve estimation: state of the art and relevance for local treatments: the Western perspective.
More than 90% of cases of hepatocellular carcinoma (HCC) develop as a consequence of underlying liver disease (most commonly viral hepatitis), often resulting in impaired liver function. In such cases, transplantation is an appealing alternative as it can potentially cure both the malignancy and the underlying disease. When transplant is not readily available due to organ scarcity, borderline cases must be considered for resection. The function of the underlying liver can be assessed by the Child Pugh score or by quantitative tests such as indocyanine green (ICG) clearance, metabolism of lidocaine to the metabolite MEG-X, and the arterial body ketone ratio (AKBR); liver biopsy pathology scoring and the platelet count can serve as indicators of fibrosis and portal hypertension. Another important factor to be considered is the risk of tumor recurrence, either because of unrecognized metastasis or due to de-novo tumor formation. Both factors must be considered in weighing resection against nonsurgical alternatives. Preoperative portal vein embolization is a strategy that can evoke regeneration in anticipation of surgery, serving as a "stress test" of the liver's regenerative capacity.
Manizate
Fotini
F
Department of Surgery, Division of Surgical Oncology, The Mount Sinai Medical Center, 5 East 98th Street, 12th Floor, Box 1259, New York, NY 10029, USA. Fotini.Manizate@mountsinai.org
Hiotis
Spiros P
SP
Labow
Daniel
D
Roayaie
Sasan
S
Schwartz
Myron
M
D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000378:metabolism* / Q000628:therapy; D004396:Coloring Agents / Q000493:pharmacokinetics; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D007208:Indocyanine Green / Q000493:pharmacokinetics; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000175:diagnosis / Q000378:metabolism* / Q000628:therapy; D016031:Liver Transplantation / Q000379:methods*; D020360:Neoadjuvant Therapy / Q000379:methods; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D014481:United States
D004396:Coloring Agents; D007208:Indocyanine Green