Assessment of liver function prior to hepatic resection

Improved surgical technique, improved anesthesia, better postoperative care and better selection of patients have all contributed to the marked decrease in mortality of partial hepatectomy over the past few years. Preoperative assessment of portal pressure and of hepatic function with indocyanine green and an oral glucose load can help identify patients who will not tolerate a major hepatic resection. The predictive value of the indocyanine green retention can be improved if the volume fraction of the liver remaining after resection is determined preoperatively by computer tomography. Factors other than hepatic function, such as age, concomitant diseases and characteristics of the operation itself, will of course also play an important role in determining the outcome of partial hepatectomy.