Major hepatectomy for hepatocellular carcinoma in patients with an unsatisfactory indocyanine green clearance test

Background: Liver failure is the commonest cause of postoperative death in patients with hepatocellular carcinoma (HCC). With the improvement in opera tive technique and perioperative care, the limit of hepatic functional rese rve may be lowered. The aim of this study was to evaluate the postoperative morbidity, mortality and survival rates in patients with an indocyanine gr een (ICG) retention value higher than 14 per cent, after major hepatectomy for HCC. Methods: From January 1994 to December 1997, 117 patients underwent major h epatectomy for HCC; 92 patients had preoperative ICG retention at 15 min lo wer than 14 per cent (median 8.3 (range 1.6-13.8) per cent), while 25 patie nts had ICG retention greater than 14 per cent (17.4 (range 14.3-35.3) per cent). Data were collected prospectively and analysed retrospectively. Results: The two groups of patients were similar in terms of age, sex ratio , preoperative platelet count, liver biochemistry, Child-Pugh status and op erative procedures performed, but the prothrombin rime was significantly lo nger in the high ICG group. The operative blood loss (1.5 litres), the amou nt of blood transfused and the number of patients requiring blood transfusi on were similar, The postoperative complication rate (41 versus 40 per cent ), duration of hospital stay (12 versus 13 days), hospital mortality rate ( 1 versus 4 per cent) and median survival time (47 versus 45 months) were no t significantly different. Conclusion: With meticulous surgical technique to decrease intraoperative b lood loss and good perioperative care, selected patients with limited hepat ic functional reserve can achieve a good immediate postoperative result and a survival rate similar to that of patients with good hepatic functional r eserve.