[Indication for hepatic resection, with special reference to functional reserve of the liver]

Liver failure is a major cause of death after hepatectomy in cirrhosis. Therefore, an accurate indication for hepatectomy should be estimated preoperatively. By using multiple regression analysis of liver function, we could accurately select any one of five possibilities in hepatic surgery: 1) trisegmentectomy , 2) lobectomy, 3) segmentectomy, 4) partial hepatectomy, and 5) no surgery, without severe postoperative complications. Furthermore, the functional reserve of the remnant liver after hepatectomy should be estimated preoperatively. We measured ICG Rmax of the remnant liver, from both the effective liver volume rate obtained by the uptake of radioisotope on a liver scan and ICG Rmax of the whole liver. If it is above 0.4 mg/kg/min, any type of hepatic resection may by possible. On postoperative management, it is also important to estimate function of the reticuloendothelial system, blood clotting mechanism, and cardio-pulmonary and renal function. ICG Rmax per unit liver volume in the remnant liver after proposed hepatectomy can be calculated preoperatively from volume of the remnant liver on CT scan and ICG Rmax of the remnant liver. If it is above 0.8 microgram/kg/min/cm3, regeneration and function of the remnant liver will remain good without any late postoperative complications after hepatectomy.