Liver resections in cirrhotic patients: A western experience

Abstract

Systematic screening for hepatocellular carcinoma (HCC) in cirrhotic patients by alpha-fetoprotein and ultrasound permits the detection of small asymptomatic tumors. Owing to the small tumor size, more liver resections can now be performed than in the past. These resections are performed in a more economical way in terms of loss of functional parenchyma and in a more appropriate manner with regard to carcinology: surgical techniques of liver segmentectomy and use of intraoperative echography are mandatory. Favorable long-term results obtained in Eastern countries by resecting such lesions are encouraging but remain to be confirmed in the Western hemisphere.

Perioperative use of the LiMON method of indocyanine green elimination measurement for the prediction and early detection of post-hepatectomy liver failure

“…Child-Pugh modification provides refined predictions of risk, however it remains unreliable, particularly with regard to discriminating between good and poor risk Child-Pugh A patients (24).…”

Review: Research Toward Safer Resectionof the Cirrhotic Liver

“…Unlike the normal liver, which, within [3][4][5][6][7][8][9][10][11][12] months can regenerate to its original size and function, even after 80% resection, the cirrhotic liver has impaired regenerative ability. Indeed, until recently, the cirrhotic liver was thought to be unable to regenerate [7].…”

“…induced cirrhosis in the rat [70]. Regeneration in cirrhotic rats as measured by 3[H]-Thymidine incorporation was markedly impaired after hepatectomy. Cirrhotic rats treated with TGFalpha, however, achieved regeneration comparable to that in non-cirrhotic rats.…”

“…Conversely, 10-20% of patients with cirrhosis from any etiology, will go on to develop HCC [3,6]. Thus, the majority of patients who require resection also have cirrhosis or impaired liver function.…”

Liver transplantation for malignancy

“…As a result of the use of tumour markers in the populations at risk and an increased use of accurate non-invasive imaging techniques, improved detection of smaller lesions within the parenchyma or hilum has occurred and this has led to a higher resectability rate (Okuda & Ishak, 1987), although this rarely exceeds 30-40% (Bismuth et al, 1986). Furthermore, a multidisciplinary approach, improvements in patient selection and management, and refined techniques in liver surgery, have contributed both to a lower perioperative mortality and improved long-term survival rates (Tang, 1985).…”