Assessment of safety in hepatic resection for hepatocellular carcinoma focusing on indirect hyperbilirubinemia.
OBJECTIVE
The indications for hepatic resection for hepatocellular carcinoma (HCC) patients with total bilirubin (T-Bil) equal to or higher than 1.2 mg/dl remain controversial. The aim of this study was to investigate the safety of hepatic resection for HCC patients who showed high T-Bil (≥1.2 mg/dl) with low direct bilirubin (D-Bil ≤ 0.5 mg/dl).


METHODS
Thirty-four HCC patients showing high T-Bil with low D-Bil were treated with mono- to tri-segmentectomy between January 2000 and December 2010. The perioperative clinical parameters and prognosis of the high T-Bil/low D-Bil patients were compared with those of 253 HCC patients showing normal T-Bil. In addition, complication rates of the patients with high T-Bil/high D-Bil (n = 4) were analyzed.


RESULTS
The prothrombin time activity, indocyanine green clearance test, asialo-scintigraphy, and platelet count were similar in the two groups. The mean serum albumin in high T-Bil/low D-Bil patients was significantly higher than that of normal T-Bil patients (4.2 ± 0.5 vs. 4.0 ± 0.4 g/dl, P = 0.004). There were no significant differences in operation time, intraoperative bleeding, red cell concentrate transfusion rate, postoperative complication rate, and disease-free and overall survivals between the two groups. Postoperative hyperbilirubinemia (T-Bil >5 mg/dl) with ascites was observed in one of four high T-Bil/high D-Bil patients (25 %).


CONCLUSIONS
Mono- to tri-segmentectomy can be performed in patients with low D-Bil (≤0.5 mg/dl) similarly to patients with low T-Bil (<1.2 mg/dl), even in HCC patients showing high T-Bil (≥1.2 mg/dl).
Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan.
Toshiro
T
Masuda
Toru
T
Beppu
Shigeki
S
Nakagawa
Hirohisa
H
Okabe
Akira
A
Chikamoto
Tatsunori
T
Miyata
Kosuke
K
Mima
Ryu
R
Otao
Hiromitsu
H
Hayashi
Koichi
K
Doi
Takatoshi
T
Ishiko
Hiroshi
H
Takamori
Hideo
H
Baba
D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D016009:Chi-Square Distribution; D017707:Erythrocyte Transfusion / Q000706:statistics & numerical data; D005260:Female; D006470:Hemorrhage / Q000453:epidemiology; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D006932:Hyperbilirubinemia / Q000150:complications*; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology; D018709:Statistics, Nonparametric; D015996:Survival Rate