Skip to main content
SpringerLink
Log in

Assessment of liver function for successful hepatectomy in patients with hepatocellular carcinoma with impaired hepatic function

  • Original Article
  • Published:
Journal of Hepato-Biliary-Pancreatic Surgery

Abstract

Background/Purpose

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 × Alb − 1.07 × HPT + 0.062 × GOT − 685 × K. ICG − 3.57 × OGTT. LI + 0.074 × 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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Albers I, Hartmann H, Bircher J, Creutzfeldt W. Superiority of the Child-Pugh classification to quantitative liver function tests for assessing prognosis of liver cirrhosis. Scand J Gastroenterol 1989;24:269–276.

    Article  PubMed  CAS  Google Scholar 

  2. Lee SG, Hwang S. How I do it: assessment of hepatic functional reserve for indication of hepatic resection. J Hepatobiliary Pancreat Surg 2005;12:38–43.

    Article  PubMed  Google Scholar 

  3. Ohwada S, Kawate S, Hamada K, Yamada T, Sunose Y, Tsutsumi H, et al. Perioperative real-time monitoring of indocyanine green clearance by pulse spectrophotometry predicts remnant liver functional reserve in resection of hepatocellular carcinoma. Br J Surg 2006;93:339–346.

    Article  PubMed  CAS  Google Scholar 

  4. Hemming AW, Gallinger S, Greig PD, Cattral MS, Langer B, Taylor BR, et al. The hippurate ratio as an indicator of functional hepatic reserve for resection of hepatocellular carcinoma in cirrhotic patients. J Gastrointest Surg 2001;5:316–321.

    Article  PubMed  CAS  Google Scholar 

  5. Lee WC, Chen MF. Assessment of hepatic reserve for indication of hepatic resection: how I do it. J Hepatobiliary Pancreat Surg. 2005;12:23–26.

    Article  PubMed  Google Scholar 

  6. Merkel C, Gatta A, Zoli M, Bolognesi M, Angeli P, Iervese T, et al. Prognostic value of galactose elimination capacity, aminopyrine breath test, and ICG clearance in patients with cirrhosis. Comparison with the Pugh score. Dig Dis Sci 1991;36:1197–1203.

    Article  PubMed  CAS  Google Scholar 

  7. Kwon AH, Ha-Kawa SK, Uetsuji S, Inoue T, Matsui Y, Kamiyama Y. Preoperative determination of the surgical procedure for hepatectomy using technetium-99m-galactosyl human serum albumin (99mTc-GSA.) liver scintigraphy. Hepatology 1997;25:426–429.

    Article  PubMed  CAS  Google Scholar 

  8. Kokudo N, Vera DR, Tada K, Koizumi M, Seki M, Matsubara T, et al. Predictors of successful hepatic resection: prognostic usefulness of hepatic asialoglycoprotein receptor analysis. World J Surg 2002;26:1342–1347.

    Article  PubMed  Google Scholar 

  9. Kubo S, Tsukamoto T, Hirohashi K, Tanaka H, Shuto T, Takemura S, et al. Correlation between preoperative serum concentration of type IV collagen 7s domain and hepatic failure following resection of hepatocellular carcinoma. Ann Surg 2004;239:186–193.

    Article  PubMed  Google Scholar 

  10. Lau H, Man K, Fan ST, Yu WC, Lo CM, Wong J. Evaluation of preoperative hepatic function in patients with hepatocellular carcinoma undergoing hepatectomy. Br J Surg 1997;84:1255–1259.

    Article  PubMed  CAS  Google Scholar 

  11. Masumoto J, Sato Y, Hori M, Murakami T, Johkoh T, Nakamura H, Tamura S. A similarity measure for nonrigid volume registration using known joint distribution of targeted tissue: application to dynamic CT data of the liver. Med Image Anal 2003;7:553–564.

    Article  PubMed  Google Scholar 

  12. Fazakas J, Mandli T, Ther G, Arkossy M, Pap S, Fule B, et al. Evaluation of liver function for hepatic resection. Transplant Proc 2006;38:798–800.

    Article  PubMed  CAS  Google Scholar 

  13. Romanelli RG, La Villa G, Barletta G, Vizzutti F, Lanini F, Arena U, et al. Long-term albumin infusion improves survival in patients with cirrhosis and ascites: an unblinded randomized trial. World J Gastroenterol 2006;12:1403–1407.

    PubMed  CAS  Google Scholar 

  14. Dudrick SJ, Kavic SM. Hepatobiliary nutrition: history and future. J Hepatobiliary Pancreat Surg. 2002;9:459–468.

    Article  PubMed  Google Scholar 

  15. Schindl MJ, Redhead DN, Fearon KC, Garden OJ, Wigmore SJ. Edinburgh Liver Surgery and Transplantation Experimental Research Group (eLISTER). The value of residual liver volume as a predictor of hepatic dysfunction and infection after major liver resection. Gut 2005;54:289–296.

    Article  PubMed  CAS  Google Scholar 

  16. Lam CM, Fan ST, Lo CM, Wong J. Major hepatectomy for hepatocellular carcinoma in patients with an unsatisfactory indocyanine green clearance test. Br J Surg 1999;86:1012–1017.

    Article  PubMed  CAS  Google Scholar 

  17. Wakabayashi H, Ishimura K, Izuishi K, Karasawa Y, Maeta H. Evaluation of liver function for hepatic resection for hepatocellular carcinoma in the liver with damaged parenchyma. J Surg Res. 2004;116:248–252.

    Article  PubMed  Google Scholar 

  18. Sasaya S, Yagi H, Yamaguchi M, Kigawa G, Nakano H, Midorikawa T, et al. Liver function assessed by increased rate of portal venous blood flow after oral intake of glucose. Eur J Surg 2000;166:112–118.

    Article  PubMed  CAS  Google Scholar 

  19. Huo TI, Lui WY, Huang YH, Chau GY, Wu JC, Lee PC, et al. Diabetes mellitus is a risk factor for hepatic decompensation in patients with hepatocellular carcinoma undergoing resection: a longitudinal study. Am J Gastroenterol 2003;98:2293–2298.

    Article  PubMed  Google Scholar 

  20. Uchiyama K, Ueno M, Hama T, Kawai M, Tani M, Terasawa H, et al. Recurrence of primary hepatocellular carcinoma after hepatectomy-differences related to underlying hepatitis virus species. Hepatogastroenterology 2005;52:591–595.

    PubMed  Google Scholar 

  21. Hasegawa K, Kokudo N, Imamura H, Matsuyama Y, Aoki T, Minagawa M, et al. Prognostic impact of anatomic resection for hepatocellular carcinoma. Ann Surg 2005;242:252–259.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Second Department of Surgery, Wakayama Medical University, School of Medicine, 811-1 Kimiidera, Wakayama, 641-8510, Japan

    Kazuhisa Uchiyama, Kazunari Mori, Katsuyoshi Tabuse, Masaki Ueno, Satoru Ozawa, Takayuki Nakase, Manabu Kawai, Masaji Tani, Hiroshi Tanimura & Hiroki Yamaue

Authors
  1. Kazuhisa Uchiyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kazunari Mori
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Katsuyoshi Tabuse
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Masaki Ueno
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Satoru Ozawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Takayuki Nakase
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Manabu Kawai
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Masaji Tani
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Hiroshi Tanimura
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Hiroki Yamaue
    View author publications

    You can also search for this author in PubMed Google Scholar

About this article

Cite this article

Uchiyama, K., Mori, K., Tabuse, K. et al. Assessment of liver function for successful hepatectomy in patients with hepatocellular carcinoma with impaired hepatic function. J Hepatobiliary Pancreat Surg 15, 596–602 (2008). https://doi.org/10.1007/s00534-007-1326-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00534-007-1326-2

Key words

Search

Navigation