scholarly journals ICG Clearance in Assessing Cirrhotic Patients with Hepatocellular Carcinoma for Major Hepatic Resection

HPB Surgery ◽  
1997 ◽  
Vol 10 (3) ◽  
pp. 182-183 ◽  
Author(s):  
Seigo Kitano ◽  
Yang-II Kim
Keyword(s):  
Hepatocellular Carcinoma ◽  
Mortality Rate ◽  
Blood Loss ◽  
Hospital Mortality ◽  
Chronic Active Hepatitis ◽  
Major Hepatectomy ◽  
Selection Criterion ◽  
Tertiary Referral Center ◽  
Icg Clearance ◽  
Cirrhotic Patients

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.

Surgical Therapy of Hepatocellular Carcinoma in the Cirrhotic Liver

Swiss Surgery ◽  
1999 ◽  
Vol 5 (3) ◽  
pp. 107-110 ◽  
Author(s):  
Fan
Keyword(s):  
Hepatocellular Carcinoma ◽  
Mortality Rate ◽  
Surgical Technique ◽  
Hospital Mortality ◽  
Normal Liver ◽  
Liver Parenchyma ◽  
Ischaemic Injury ◽  
Liver Remnant ◽  
Cirrhotic Patients ◽  
Major Hepatectomies

Hepatectomy for hepatocellular carcinoma (HCC) associated with cirrhosis was considered by some surgeons contraindicated because the hospital mortality rate, especially for major hepatectomy, was very high. The author reported his surgical approach to hepatectomy associated with cirrhosis. Between 1989 and 1995, 66 major hepatectomies and 32 minor hepatectomies were performed in 98 cirrhotic patients. The selection of patients for hepatectomy was based on results of indocyanine green clearance test. The surgical technique was designed to reduce blood loss, ischaemic injury to the liver remnant and preservation of liver parenchyma. The postoperative care was designed to maintain or improve liver function. By such an approach, the hospital mortality rate of the cirrhotic patients having hepatectomy decreased from 40% in 1989 to 5% in 1995. The 5-year survival rate also improved to 41.2%, which is not statistically different from that of those with a normal liver or chronic hepatitis. With refinement in surgical technique and perioperative care, patients with cirrhosis can also benefit from hepatectomy for HCC.

scholarly journals In-hospital mortality associated with transcatheter arterial embolization for treatment of hepatocellular carcinoma in patients on hemodialysis for end stage renal disease: a matched-pair cohort study using a nationwide database

BJR|Open ◽  
2019 ◽  
Vol 1 (1) ◽  
pp. 20190004
Author(s):  
Masaya Sato ◽  
Ryosuke Tateishi ◽  
Hideo Yasunaga ◽  
Hiroki Matsui ◽  
Kiyohide Fushimi ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Mortality Rate ◽  
Hospital Mortality ◽  
End Stage Renal Disease ◽  
Odds Ratio ◽  
Matched Pair ◽  
Complication Rates ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Objectives: No previous study has evaluated the risks associated with transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma in patients on hemodialysis (HD) for end stage renal disease (ESRD), because invasive treatment is rarely performed for such patients. We used a nationwide database to investigate in-hospital mortality and complication rates following TACE in patients on HD for ESRD. Methods: Using the Japanese Diagnosis Procedure Combination database, we enrolled patients on HD for ESRD who underwent TACE for hepatocellular carcinoma. For each patient, we randomly selected up to four non-dialyzed patients using a matched-pair sampling method based on the patient’s age, sex, treatment hospital, and treatment year. In-hospital mortality and complication rates were compared between dialyzed and non-dialyzed patients following TACE. Results: We compared matched pairs of 1551 dialyzed and 5585 non-dialyzed patients. Although the complication rate did not differ between the dialyzed and non-dialyzed ESRD patients [5.7% vs 5.8%, respectively; odds ratio, 0.99; 95% confidence interval (0.79–1.23); p = 0.90], the in-hospital mortality rate was significantly higher in dialyzed ESRD patients than in non-dialyzed patients [2.2% vs 0.97%, respectively; odds ratio, 2.21; 95% confidence interval (1.44–3.40); p < 0.001]. Among the dialyzed patients, the mortality rate was not significantly associated with sex, age, Charlson comorbidity index, or hospital volume. Conclusions: The in-hospital mortality rate following TACE was 2.2 % and was significantly higher in dialyzed than in non-dialyzed ESRD patients. The indications for TACE in HD-dependent patients should be considered carefully with respect to the therapeutic benefits vs risks. Advances in knowledge: In hospital mortality rate following TACE in dialyzed patients was more than twice compared to non-dialyzed patients. Post-procedural complication following TAE in ESRD onHD patients was 5.7%, and did not differ from that in non dialyzed patients.

Outcomes of Pure Laparoscopic versus Open Hepatic Resection for Hepatocellular Carcinoma in Cirrhotic Patients: A Case-Control Study with Propensity Score Matching

2015 ◽  
Vol 55 (4) ◽  
pp. 291-301 ◽  
Author(s):  
Shogo Tanaka ◽  
Shigekazu Takemura ◽  
Hiroji Shinkawa ◽  
Takayoshi Nishioka ◽  
Genya Hamano ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Propensity Score ◽  
Blood Loss ◽  
Hepatic Resection ◽  
Propensity Score Matching ◽  
Activity Index ◽  
Disease Free Survival ◽  
Intraoperative Blood Loss ◽  
Laparoscopic Hepatic Resection ◽  
Cirrhotic Patients

Background/Purpose: Laparoscopic hepatic resection (LH) for hepatocellular carcinoma (HCC) has gradually gained ground as a safe and minimally invasive treatment, although LH for cirrhotic patients remains challenging. Methods: Between January 2007 and August 2014, 28 and 57 patients with histologically proven cirrhosis (histological activity index, fibrosis score 4) underwent pure LH and open hepatic resection (OH; less than segmentectomy), respectively, for peripheral HCC ≤5 cm. To correct the difference in clinicopathological factors, including difficulty scores, between the two groups, propensity score matching was used at a 1:1 ratio, which resulted in a comparison of 20 patients per group. We compared the short- and long-term outcomes of LH and OH to investigate the efficacy of LH. Results: Clinicopathological variables, including difficulty scores, were well balanced between the two groups. The incidence of complications and mean intraoperative blood loss were lower in the LH group than the OH group (0 vs. 45% and 180 vs. 440 ml, p = 0.001 and 0.04, respectively). The 3-year disease-free survival rate was 42% in the LH group and 30% in the OH group (p = 0.533), whereas the 5-year overall survival rates were 46 and 60%, respectively (p = 0.606). Conclusions: LH is a safe and effective treatment option for cirrhotic patients with HCC in terms of intraoperative blood loss and morbidity.

scholarly journals Cirrhosis aggravates the ninety-day mortality after liver resection for hepatocellular carcinoma

2019 ◽  
Vol 6 (8) ◽  
pp. 2869
Author(s):  
Hosam Farouk Abdelhameed ◽  
Ashraf M. El-Badry
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Resection ◽  
Hospital Mortality ◽  
Postoperative Mortality ◽  
University Hospital ◽  
Control Group ◽  
Complication Rates ◽  
Hospital Stays ◽  
Cirrhotic Patients ◽  
Prolonged Hospital

Background: Ninety-day postoperative mortality (90-D POM) measures accurately the liver resection-related mortality. In cirrhotic patients, reporting post-hepatectomy-related death only as in-hospital or thirty-day postoperative mortality (30-D POM) may underestimate cirrhosis-related death after liver resection.Methods: Medical records of adult cirrhotic (cirrhosis group) and matched non-cirrhotic (control group) patients, who underwent elective liver resection at Sohag University Hospital (April 2014- March 2018), were analyzed. The 90-D POM versus in-hospital mortality and 30-D POM were compared in both groups.Results: Forty-six patients (23 per group) were eligible for the study. Liver resection was carried out in all cirrhosis group patients for hepatocellular carcinoma (HCC). In the control group, liver resection was indicated for colorectal metastasis (13), benign masses (7) and intrahepatic cholangiocarcinoma (3). Compared with the control group, cirrhotic patients exhibited significantly higher complication rates (p<0.05), prolonged hospital stays (p<0.05), increased postoperative levels of serum bilirubin and reduced prothrombin concentration (p<0.05). In the control group, in-hospital mortality and 30-D POM were zero while 90-D POM was 4%. In the cirrhosis group, the in-hospital mortality and 30-D POM were identical (8.7%), however the 90-D POM was significantly higher and almost doubled (17%). Conclusion: Liver cirrhosis triggers significant mortality that may extend for ninety days postoperatively. In cirrhotic patients, post-hepatectomy death should be reported as 90-D POM rather than the obviously misleading in-hospital mortality or 30-D POM.

scholarly journals Does Risk Calculator by Nationwide Survey Match The Postoperative Outcome in Patients Who Underwent Major Hepatectomy?

2020 ◽  
Author(s):  
Atsushi Nanashima ◽  
Naoya Imamura ◽  
Masahide Hiyoshi ◽  
Koichi Yano ◽  
Takeomi Hamada ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Hospital Mortality ◽  
High Mortality ◽  
Major Hepatectomy ◽  
Nationwide Survey ◽  
Hospital Death ◽  
Risk Calculator ◽  
Biliary Malignancy ◽  
Co Morbidity ◽  
Hepatobiliary Diseases

Abstract Background: To clarify significance of the present National Clinical Database risk calculator (NCD-RC) for hepatectomy in Japan, relationship between perioperative parameters or outcomes in major hepatectomy and the mortality rate by NCD-RC was examined. Methods: Patient demographics, co-morbidity, surgical records, postoperative morbidity or mortality were examined and compared to the 30 days- or in-hospital-mortality rate among 55 patients with hepatobiliary diseases who underwent hemi- or more-extended hepatectomy and central (segment 458) hepatectomy. The cut-off percent for high risk mortality before hepatectomy was set at 5% in this period. Results: In-hospital morbidity over CD III was 17 (28%), The 30-day mortality and in-hospital mortality was nil and two (3%), respectively. Male patient showed significantly higher in-hospital mortality rate (p<0.01). In the 37 patients (group woML), mean age was 67.8±8.7 years old ranging 45 and 84. Others included A) with severe complications or mortality in whom low mortality rate (group wML, n=13), B) without severe complications neither mortality in whom high mortality rate (group woMH, n=7), and C) with severe complications or mortality in whom high mortality rate (group wMH, n=4 (6.5%)). Age, distribution of elderly patients, gender, the hepatobiliary diseases and the prevalence of preoperative co-morbidity were not significantly different between groups. In the group wML, the bile leakage was dominant and, however, the in-hospital death was not observed. In the group wMH, all operations were right hepatectomy with bile duct resection (RH-BDR) for biliary malignancy and two died of hepatic failure and, however, the prevalence of RH-BDR was not significantly higher in comparison with other groups. Conclusions: Predictive mortality rate by risk calculator under nationwide survey did not always match with patient outcomes in the actual clinical setting and further improvement will be required. In case of RH-BDR for biliary malignancy with high predictive rate, the careful perioperative managements is important under the present nationwide database.

scholarly journals Child-Pugh Parameters and Platelet Count as an Alternative to ICG Test for Assessing Liver Function for Major Hepatectomy

HPB Surgery ◽  
2017 ◽  
Vol 2017 ◽  
pp. 1-8 ◽  
Author(s):  
Kin-Pan Au ◽  
See-Ching Chan ◽  
Kenneth Siu-Ho Chok ◽  
Albert Chi-Yan Chan ◽  
Tan-To Cheung ◽  
...  
Keyword(s):  
Platelet Count ◽  
Liver Function ◽  
Hospital Mortality ◽  
Major Hepatectomy ◽  
Retention Rate ◽  
Disease Free Survival ◽  
Term Survival ◽  
Icg Clearance ◽  
Icg Clearance Test ◽  
Clearance Test

Objective. To study the correlations and discrepancies between Child-Pugh system and indocyanine green (ICG) clearance test in assessing liver function reserve and explore the possibility of combining two systems to gain an overall liver function assessment. Design. Retrospective analysis of 2832 hepatocellular carcinoma (HCC) patients graded as Child-Pugh A and Child-Pugh B with ICG clearance test being performed was conducted. Results. ICG retention rate at 15 minutes (ICG15) correlates with Child-Pugh score, however, with a large variance. Platelet count improves the correlation between Child-Pugh score and ICG15. ICG15 can be estimated using the following regression formula: estimated ICG15 (eICG15) = 45.1 + 0.435 × bilirubin − 0.917 × albumin + 0.491 × prothrombin time − 0.0283 × platelet (R2=0.455). Patients with eICG15 >20.0% who underwent major hepatectomy had a tendency towards more posthepatectomy liver failure (4.1% versus 8.0%, p=0.09) and higher in-hospital mortality (3.7% versus 8.0%, p=0.052). They also had shorter median overall survival (5.10±0.553 versus 3.01±0.878 years, p=0.015) and disease-free survival (1.37±0.215 versus 0.707±0.183 years, p=0.018). Conclusion. eICG15 can be predicted from Child-Pugh parameters and platelet count. eICG15 correlates with in-hospital mortality after major hepatectomy and predicts long-term survival.

Outcomes and prognostic factors of cirrhotic patients with hepatocellular carcinoma after radical major hepatectomy

2007 ◽  
Vol 31 (9) ◽  
pp. 1782-1787 ◽  
Author(s):  
Li Zhou ◽  
Jing-An Rui ◽  
Shao-Bin Wang ◽  
Shu-Guang Chen ◽  
Qiang Qu ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Prognostic Factors ◽  
Major Hepatectomy ◽  
Cirrhotic Patients

Characteristic Risk Factors in Cirrhotic Patients for Posthepatectomy Complications: Comparison with Noncirrhotic Patients

2014 ◽  
Vol 80 (2) ◽  
pp. 166-170 ◽  
Author(s):  
Shinji Itoh ◽  
Hideaki Uchiyama ◽  
Hirofumi Kawanaka ◽  
Takahiro Higashi ◽  
Akinori Egashira ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Loss ◽  
Major Hepatectomy ◽  
Significant Risk ◽  
Intraoperative Blood Loss ◽  
Hepatic Reserve ◽  
Cirrhotic Patients ◽  
Independent Risk Factors ◽  
Duration Of Operation ◽  
Cirrhotic Group

There seemed to be characteristic risk factors in cirrhotic patients for posthepatectomy complications because these patients have less hepatic reserve as compared with noncirrhotic patients. The aim of the current study was to identify these characteristic risk factors in cirrhotic patients. We performed 419 primary hepatectomies for hepatocellular carcinoma. The patients were divided into the cirrhotic group (n = 198) and the noncirrhotic group (n = 221), and the risk factors for posthepatectomy complications were compared between the groups. Thirty-six cirrhotic patients (18.2%) experienced Clavien's Grade III or more complications. Tumor size, intraoperative blood loss, duration of operation, major hepatectomy (two or more segments), and necessity of blood transfusion were found to be significant risk factors in univariate analyses. Multivariate analysis revealed that major hepatectomy and intraoperative blood loss were independent risk factors for posthepatectomy complications in patients with cirrhosis. On the other hand, the duration of operation was only an independent risk factor for posthepatectomy complication in noncirrhotic patients. Cirrhotic patients should avoid a major hepatectomy and undergo a limited resection preserving as much liver tissue as possible and meticulous surgical procedures to lessen intraoperative blood loss are mandatory to prevent major posthepatectomy complications.

scholarly journals Institutional actual utilization of postoperative mortality using nationwide survey based risk calculator in patients who underwent major hepatectomy

2021 ◽  
Author(s):  
Atsushi Nanashima ◽  
Naoya Imamura ◽  
Masahide Hiyoshi ◽  
Koichi Yano ◽  
Takeomi Hamada ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Hospital Mortality ◽  
High Mortality ◽  
Major Hepatectomy ◽  
Postoperative Mortality ◽  
Nationwide Survey ◽  
Bile Leakage ◽  
Risk Calculator ◽  
Biliary Malignancy ◽  
Co Morbidity

Background: Relationship between outcomes of major hepatectomy and the mortality rate predicted by National Clinical Database risk calculator (NCD-RC) was examined . Methods: Patient demographics and postoperative morbidity and mortality were compared between 30-day and in-hospital mortality rates among 55 patients who underwent major hepatectomies . The cut-off value for high-risk mortality was set at 5%. Patients were divided into four groups: A) no severe complications and low predictive mortality rate (woML) , B) severe complications or mortality, and low mortality rate (wML) , C) no severe complications and high mortality rate (woMH) , and D) severe complications or mortality, and high mortality rate (wMH) . Results: Morbidity higher than CD III occurred in 17 patients (28%) and 30-day and in-hospital mortality in none and two (3%), respectively. The in-hospital mortality rate was significantly higher for male patients (p&lt;0.01). Age, elderly patients, diseases, and co-morbidity did not significantly differ among groups. Although bile leakage was common in group wML , there were no in-hospital deaths. All surgical procedures performed in group wMH were right hepatectomy with bile duct resection (RH-BDR) for biliary malignancy, and two died of hepatic failure; however, the incidence of RH-BDR was not significantly higher than those in other groups. Conclusions: Preoperative mortality rate predicted by NCD-RC was not always consistent with outcomes in actual clinical settings and further improvements are needed. In case of RH-BDR for biliary malignancy with high predictive mortality rate, careful decision making for liver function and perioperative management are required.

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