Preoperative estimation of surgical risk of hepatectomy in cirrhotic patients

In order to improve the results of hepatectomy in cirrhotic patients, functional resectability of the liver was evaluated before surgery, in 119 cases of hepatectomy, including 85 cases with cirrhosis, over the last 10 years. Our total risk, measured by multivariate analysis of hepatic function tests, was very useful in selecting the suitable operative method. Functional reserve of the remnant liver and that of per unit volume of the liver evaluated by ICGRmax, were also good indicators for estimating long-term prognosis and liver regeneration following hepatectomy. Furthermore, from our experience with 4 cirrhotic patients who developed disseminated intravascular coagulopathy after hepatectomy, the preoperative evaluation of function in the coagulation-fibrinolysis system was also important for estimating the operative risk of hepatectomy in cirrhotic patients.