Risk prediction using histology of noncancerous liver before hepatic resection for hepatocellular carcinoma

Background/Aims: The aim of this study is to elucidate the feasibility of t he risk assessment of hepatic resection by histological evaluation of nonca ncerous liver in patients with hepatocellular carcinoma. Methodology: The study involved 78 patients with hepatocellular carcinoma w ho had undergone a needle biopsy of noncancerous liver before hepatic resec tion. The histological activity index score which consists of four categori es indicating the inflammatory activity and the degree of fibrosis was dete rmined, and its association with complications after hepatic resection was examined. Results: Postoperative complications occurred in 26 of the first 52 patient s that underwent hepatic resection. A logistic analysis selected histologic al activity index score as an independent factor related to post operative complications (Odds ratio 1.31, P <0.02). Postoperative complications occur red more frequently in patients with a histological activity index score gr eater than or equal to6 that had undergone resection of two or more segment s (P <0.05), and also in those with histological activity index score great er than or equal to 10 that had undergone segmentectomy or subsegmentectomy (P <0.05). When the histological activity index score was taken into consi deration in deciding operative procedures for a further 20 patients, the in cidence of postoperative complications reduced considerably to 10%. Conclusions: Preoperative histological evaluation of noncancerous liver by a needle biopsy may be helpful in deciding the operative procedure to avoid complications after hepatic resection for hepatocellular carcinoma.