BACKGROUND: Most patients with hepatocellular carcinoma (HCC) have underlying liver disease and a preoperative liver function evaluation is important to avoid postoperative liver failure and death. In Western guidelines, portal hypertension (PH) is listed as a contraindication for liver resection. On the other hand, the indocyanine green retention rate at 15 min (ICG R15) has been widely used in Asian countries for surgical decision making. However, these criteria are based on reports published in the 20th century that included only a small number of patients and were developed empirically. SUMMARY: The number of published case series concerning liver resection in HCC patients with PH has been rapidly increasing since 2011, indicating that liver resection in HCC patients with PH is now routinely performed in specialized centers worldwide. Although PH certainly has an impact and should be considered as a contraindication for major liver resection, it is no longer considered to be a contraindication for minor liver resection, especially laparoscopic liver resection. In addition, new biomarkers and imaging tools to assess preoperative liver function have been extensively reported. The combination of these new factors to well-known risk factors, such as PH and ICG R15, might strengthen the ability to stratify the risk of postoperative liver failure. KEY MESSAGES: The present review covers recent topics regarding the assessment of preoperative liver function for surgical decision making in patients with HCC.
BACKGROUND: Most patients with hepatocellular carcinoma (HCC) have underlying liver disease and a preoperative liver function evaluation is important to avoid postoperative liver failure and death. In Western guidelines, portal hypertension (PH) is listed as a contraindication for liver resection. On the other hand, the indocyanine green retention rate at 15 min (ICG R15) has been widely used in Asian countries for surgical decision making. However, these criteria are based on reports published in the 20th century that included only a small number of patients and were developed empirically. SUMMARY: The number of published case series concerning liver resection in HCC patients with PH has been rapidly increasing since 2011, indicating that liver resection in HCC patients with PH is now routinely performed in specialized centers worldwide. Although PH certainly has an impact and should be considered as a contraindication for major liver resection, it is no longer considered to be a contraindication for minor liver resection, especially laparoscopic liver resection. In addition, new biomarkers and imaging tools to assess preoperative liver function have been extensively reported. The combination of these new factors to well-known risk factors, such as PH and ICG R15, might strengthen the ability to stratify the risk of postoperative liver failure. KEY MESSAGES: The present review covers recent topics regarding the assessment of preoperative liver function for surgical decision making in patients with HCC.
Authors: Pim B Olthof; Federico Tomassini; Pablo E Huespe; Stephanie Truant; François-René Pruvot; Roberto I Troisi; Carlos Castro; Erik Schadde; Rimma Axelsson; Ernesto Sparrelid; Roelof J Bennink; Rene Adam; Thomas M van Gulik; Eduardo de Santibanes Journal: Surgery Date: 2017-07-18 Impact factor: 3.982
Authors: Victor M Zaydfudim; Matthew J Kerwin; Florence E Turrentine; Todd W Bauer; Reid B Adams; George J Stukenborg Journal: Surgery Date: 2015-12-31 Impact factor: 3.982
Authors: K Kubota; M Makuuchi; K Kusaka; T Kobayashi; K Miki; K Hasegawa; Y Harihara; T Takayama Journal: Hepatology Date: 1997-11 Impact factor: 17.425
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Authors: Xuefeng Kan; Feng Zhang; Guanhui Zhou; Hongxiu Ji; Wayne Monsky; Christopher Ingraham; Chuansheng Zheng; Xiaoming Yang Journal: Proc Natl Acad Sci U S A Date: 2021-10-12 Impact factor: 11.205