Assessment of liver function for safe hepatic resection.

Area of Science:

• Hepatology
• Surgical Oncology
• Diagnostic Imaging

Background:

• Preoperative liver function assessment is vital for patient outcomes following hepatic resection.
• Conventional liver function tests and general scores (e.g., Child-Turcotte-Pugh, MELD) have limitations in predicting risk, especially in mild to moderate liver dysfunction.
• Quantitative liver function tests provide more precise assessments, overcoming drawbacks of general scores.

Purpose of the Study:

• To review the importance of liver function tests in predicting outcomes after hepatic resection.
• To highlight the advantages of quantitative liver function tests over conventional methods.
• To discuss the role of indocyanine green retention rate at 15 minutes (ICG R15) and related criteria in surgical decision-making.

Main Methods:

• Review of existing literature on liver function tests for hepatic resection.
• Comparison of conventional tests (Child-Turcotte-Pugh, MELD) with quantitative methods (ICG R15).
• Discussion of the Makuuchi criteria and the use of preoperative portal vein embolization.

Main Results:

• Indocyanine green retention rate at 15 minutes (ICG R15) is a significant predictor of postoperative liver failure and mortality.
• The Makuuchi criteria, utilizing ICG R15, enable safe hepatic resection with near-zero mortality.
• Quantitative tests like ICG R15 and galactosyl human serum albumin-diethylenetriamine-pentaacetic acid scintigraphy offer superior risk stratification and surgical planning.

Conclusions:

• Quantitative liver function tests, particularly ICG R15, are superior to general scores for assessing operative risk in hepatic resection.
• The Makuuchi criteria provide a reliable decision-making framework for patient selection and surgical procedure planning.
• Further validation and simplification of other quantitative liver function tests are needed.