title: Validation of the Conventional Resection Criteria in Patients with Hepatocellular Carcinoma in Terms of the Incidence of Posthepatectomy Liver Failure and Long-Term Prognosis.
abstract: OBJECTIVE
  Resection criteria in hepatocellular carcinoma (HCC) should be established based on the risk of posthepatectomy liver failure (PHLF) and the survival benefit from hepatectomy. This study aimed at verifying the validity of the conventional criteria regarding the incidence of PHLF and the long-term prognosis of HCC patients.
  
  
  METHODS
  A retrospective study was performed on 265 patients who underwent major hepatectomy. Makuuchi's criteria and the future liver remnant plasma clearance rate of indocyanine green (ICGK-rem) ≥0.05 criterion were evaluated.
  
  
  RESULTS
  A total of 107 and 158 patients were within and beyond Makuuchi's criteria, respectively. Makuuchi's criteria were associated with the incidence of PHLF (p = 0.03) but not with its severity (p = 0.12). No differences in disease-free survival (DFS) or overall survival (OS) were observed between the groups (p = 0.75 and p = 0.94, respectively). Using the ICGK-rem ≥0.05 criterion, 223 and 42 patients were within and beyond the criterion, respectively. ICGK-rem was correlated with both the incidence of PHLF (p = 0.002) and its severity (p = 0.03). No differences in DFS or OS were observed between the groups (p = 0.75 and p = 0.29, respectively).
  
  
  CONCLUSIONS
  Strict criteria are likely to preclude some patients from obtaining the greater survival benefits of hepatectomy. New criteria that consider patient prognosis are needed.
authors.affiliation: Department of Surgery, Graduate School of Medicine, Kyoto University Hospital, Kyoto, Japan.
authors.forename: Kohta
authors.initials: K
authors.lastname: Iguchi
authors.forename: Etsuro
authors.initials: E
authors.lastname: Hatano
authors.forename: Kenya
authors.initials: K
authors.lastname: Yamanaka
authors.forename: Shiro
authors.initials: S
authors.lastname: Tanaka
authors.forename: Kojiro
authors.initials: K
authors.lastname: Taura
authors.forename: Shinji
authors.initials: S
authors.lastname: Uemoto
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000601:surgery*; D000066491:Clinical Decision-Making; D003661:Decision Support Techniques; D005260:Female; D006498:Hepatectomy; D006801:Humans; D015994:Incidence; D017093:Liver Failure / Q000453:epidemiology / Q000209:etiology*; D008113:Liver Neoplasms / Q000401:mortality / Q000601:surgery*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis