ICG Clearance in Assessing Cirrhotic Patients with Hepatocellular Carcinoma for Major Hepatic ResectionReport as inadecuate

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HPB Surgery - Volume 10 1997, Issue 3, Pages 182-183

Department of Surgery I, Oita Medical University, Oita 879-55, Japan

Department of Surgery, Catholic University of Taegu-Hyosung, School of Medicine, Taegu 705-034, Korea

Copyright © 1997 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Objective: To deWne the safety of major hepatectomy for hepatocellular carcinoma HCC associated with cirrhosis and the selection criteria for surgery in terms of hospital mortality.

Design: Major hepatectomy for HCC in the presence of cirrhosis is considered to be contraindicated by many surgeons because the reported mortality rate is high 26% to 50%. Previous workers recommended that only selected patients with Child-s A status or indocyanine green ICG retention at 15 minutes of less than 10% undergo major hepatectomy. A survery was made, therefore, of our patients with HCC and cirrhosis undergoing major hepatectomy between 1989 and 1994.

Setting: A tertiary referral center.

Patients: The preoperative, intraoperative, and post-operative data of 54 patients with cirrhosis who had major hepatectomy were compared with those of 25 patients with underlying chronic active hepatitis and 22 patients with normal livers undergoing major hepatectomy for HCC. The data had been prospectively collected.

Intervention: Major hepatectomy, defined as resection of two or more liver segments by Goldsmith and Woodburn nomenclature, was performed on all the patients. Main Outcome Measure: Hospital mortality, which was defined as death within the same hospital admission for the hepatectomy.

Results: Preoperative liver function in patients with cirrhosis was worse than in those with normal livers. The intraoperative blood loss was also higher P=.01, but for patients with cirrhosis, chronic active hepatitis, and normal livers, the hospital mortality rates 13%, 16%, and 14%, respectively were similar. The hospital mortality rate for patients with cirrhosis in the last 2 years of the study was only 5%. Patients with cirrhosis could tolerate up to 10 L of blood loss and survive the major hepatectomy. By discriminant analysis, an ICG retention of 14% at 15 minutes was cutoff level that could maximally separate the patients with cirrhosis with and without mortality.

Conclusion: Major hepatectomy for HCC in the presence of cirrhosis is associated with a mortality rate that is not different from the rate for patients with normal livers. An ICG retention of 14% at 15 minutes would serve as a better selection criterion than the 10% previously used.

Author: Seigo Kitano and Yang-II Kim

Source: https://www.hindawi.com/


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