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Article: Methods and related drawbacks in estimation of surgical risks in cirrhotic patients undergoing hepatectomy

TitleMethods and related drawbacks in estimation of surgical risks in cirrhotic patients undergoing hepatectomy
Authors
Issue Date2002
PublisherHepato-Gastroenterology. The Journal's web site is located at http://www.thieme.de/hepato/index.html
Citation
Hepato-Gastroenterology, 2002, v. 49 n. 43, p. 17-20 How to Cite?
AbstractThere has been a dramatic improvement in recent results of hepatectomy for hepatocellular carcinoma in cirrhotic patients. Hospital mortality rates of less than 5% are frequently reported. The improvement is largely a result of better techniques and performance of surgeons in hepatectomy, and reduction in blood loss and transfusion requirement. Better selection of patients is perhaps a more significant contributory factor. Careful identification of risk factors related to the medical condition of the patient, functional reserve of the liver and volume of the remnant liver is essential for the prevention of postoperative liver failure. Indocyanine green clearance test is the most accurate test for assessment of liver function reserve. An indocyanine green retention rate of 14% at 15 minutes is the safety limit for major hepatectomy for cirrhotic patients. A maximum of 60% of the nontumorous liver can be resected safely. Computed tomography is therefore an important assessment parameter. The liver function reserve also reveals the suitability for hepatectomy. Liver enzymes, alanine aminotransferase or aspartate aminotransferase can reflect the hepatic activity, which could be responsible for the impaired liver function. Steatosis is another factor that influences hepatic function reserve. Age is also an important risk factor in hepatectomy because elderly patients may harbor occult heart disease, reduced respiratory and liver function reserves. After recognizing the risk factors, surgeons should eliminate operative morbidity and mortality by making appropriate decisions based on the assessments. In conclusion, preoperative risk assessment involves evaluation of hepatic function reserve, remnant liver volume, liver status, age and the medical condition of the patient. A 0% hospital mortality rate is considered the objective.
Persistent Identifierhttp://hdl.handle.net/10722/172802
ISSN
2015 Impact Factor: 0.792
2015 SCImago Journal Rankings: 0.446
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorFan, STen_US
dc.date.accessioned2012-10-30T06:25:00Z-
dc.date.available2012-10-30T06:25:00Z-
dc.date.issued2002en_US
dc.identifier.citationHepato-Gastroenterology, 2002, v. 49 n. 43, p. 17-20en_US
dc.identifier.issn0172-6390en_US
dc.identifier.urihttp://hdl.handle.net/10722/172802-
dc.description.abstractThere has been a dramatic improvement in recent results of hepatectomy for hepatocellular carcinoma in cirrhotic patients. Hospital mortality rates of less than 5% are frequently reported. The improvement is largely a result of better techniques and performance of surgeons in hepatectomy, and reduction in blood loss and transfusion requirement. Better selection of patients is perhaps a more significant contributory factor. Careful identification of risk factors related to the medical condition of the patient, functional reserve of the liver and volume of the remnant liver is essential for the prevention of postoperative liver failure. Indocyanine green clearance test is the most accurate test for assessment of liver function reserve. An indocyanine green retention rate of 14% at 15 minutes is the safety limit for major hepatectomy for cirrhotic patients. A maximum of 60% of the nontumorous liver can be resected safely. Computed tomography is therefore an important assessment parameter. The liver function reserve also reveals the suitability for hepatectomy. Liver enzymes, alanine aminotransferase or aspartate aminotransferase can reflect the hepatic activity, which could be responsible for the impaired liver function. Steatosis is another factor that influences hepatic function reserve. Age is also an important risk factor in hepatectomy because elderly patients may harbor occult heart disease, reduced respiratory and liver function reserves. After recognizing the risk factors, surgeons should eliminate operative morbidity and mortality by making appropriate decisions based on the assessments. In conclusion, preoperative risk assessment involves evaluation of hepatic function reserve, remnant liver volume, liver status, age and the medical condition of the patient. A 0% hospital mortality rate is considered the objective.en_US
dc.languageengen_US
dc.publisherHepato-Gastroenterology. The Journal's web site is located at http://www.thieme.de/hepato/index.htmlen_US
dc.relation.ispartofHepato-Gastroenterologyen_US
dc.subject.meshAge Factorsen_US
dc.subject.meshBody Weights And Measuresen_US
dc.subject.meshCarcinoma, Hepatocellular - Complications - Mortality - Surgeryen_US
dc.subject.meshComorbidityen_US
dc.subject.meshHepatectomy - Methods - Mortalityen_US
dc.subject.meshHumansen_US
dc.subject.meshIndocyanine Green - Diagnostic Useen_US
dc.subject.meshLiver - Anatomy & Histology - Surgeryen_US
dc.subject.meshLiver Cirrhosis - Complications - Mortalityen_US
dc.subject.meshLiver Function Testsen_US
dc.subject.meshLiver Neoplasms - Complications - Mortality - Surgeryen_US
dc.subject.meshRisk Factorsen_US
dc.subject.meshTreatment Outcomeen_US
dc.titleMethods and related drawbacks in estimation of surgical risks in cirrhotic patients undergoing hepatectomyen_US
dc.typeArticleen_US
dc.identifier.emailFan, ST: stfan@hku.hken_US
dc.identifier.authorityFan, ST=rp00355en_US
dc.description.naturelink_to_subscribed_fulltexten_US
dc.identifier.pmid11941945-
dc.identifier.scopuseid_2-s2.0-0036215279en_US
dc.identifier.hkuros68705-
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-0036215279&selection=ref&src=s&origin=recordpageen_US
dc.identifier.volume49en_US
dc.identifier.issue43en_US
dc.identifier.spage17en_US
dc.identifier.epage20en_US
dc.identifier.isiWOS:000174721200004-
dc.publisher.placeGreeceen_US
dc.identifier.scopusauthoridFan, ST=7402678224en_US

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