Abstract
Background/purpose
The indications for hepatic resection for hepatocellular carcinoma (HCC) patients with total bilirubin (T-Bil) equal to or higher than 1.2 mg/dl remain controversial. The aim of this study was to investigate the safety of hepatic resection for HCC patients who showed high T-Bil (≥1.2 mg/dl) with low direct bilirubin (D-Bil ≤ 0.5 mg/dl).
Methods
Thirty-four HCC patients showing high T-Bil with low D-Bil were treated with mono- to tri-segmentectomy between January 2000 and December 2010. The perioperative clinical parameters and prognosis of the high T-Bil/low D-Bil patients were compared with those of 253 HCC patients showing normal T-Bil. In addition, complication rates of the patients with high T-Bil/high D-Bil (n = 4) were analyzed.
Results
The prothrombin time activity, indocyanine green clearance test, asialo-scintigraphy, and platelet count were similar in the two groups. The mean serum albumin in high T-Bil/low D-Bil patients was significantly higher than that of normal T-Bil patients (4.2 ± 0.5 vs. 4.0 ± 0.4 g/dl, P = 0.004). There were no significant differences in operation time, intraoperative bleeding, red cell concentrate transfusion rate, postoperative complication rate, and disease-free and overall survivals between the two groups. Postoperative hyperbilirubinemia (T-Bil >5 mg/dl) with ascites was observed in one of four high T-Bil/high D-Bil patients (25 %).
Conclusions
Mono- to tri-segmentectomy can be performed in patients with low D-Bil (≤0.5 mg/dl) similarly to patients with low T-Bil (<1.2 mg/dl), even in HCC patients showing high T-Bil (≥1.2 mg/dl).
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Kubota K, Makuuchi M, Kusaka K, Kobayashi T, Miki K, Hasegawa K, et al. Measurement of liver volume and hepatic functional reserve as a guide to decision-making in resectional surgery for hepatic tumors. Hepatology. 1997;26:1176–81.
Miyagawa S, Makuuchi M, Kawasaki S, Kakazu T. Criteria for safe hepatic resection. Am J Surg. 1995;169:589–94.
Strassburg CP. Hyperbilirubinemia syndromes (Gilbert–Meulengracht, Crigler–Najjar, Dubin–Johnson, and Rotor syndrome). Best Pract Res Clin Gastroenterol. 2010;24:555–71.
Pugh RN, Murray-Lyon IM, Dawson JL, Pietroni MC, Williams R. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg. 1973;60:646–9.
Ikai I, Arii S, Kojiro M, Ichida T, Makuuchi M, Matsuyama Y, et al. Reevaluation of prognostic factors for survival after liver resection in patients with hepatocellular carcinoma in a Japanese nationwide survey. Cancer. 2004;101:796–802.
Roche SP, Kobos R. Jaundice in the adult patient. Am Fam Physician. 2004;69:299–304.
Beppu T, Hayashi H, Okabe H, Masuda T, Mima K, Otao R, et al. Liver functional volumetry for portal vein embolization using a newly developed (99m)Tc-galactosyl human serum albumin scintigraphy SPECT-computed tomography fusion system. J Gastroenterol. 2011;46:938–43.
Yoshida H, Katayose Y, Rikiyama T, Motoi F, Onogawa T, Egawa S, et al. Segmentectomy of the liver. J Hepatobiliary Pancreat Sci. 2012;19:67–71.
Osada S, Saji S. The clinical significance of monitoring alkaline phosphatase level to estimate postoperative liver failure after hepatectomy. Hepatogastroenterology. 2004;51:1434–8.
Kubo S, Tsukamoto T, Hirohashi K, Tanaka H, Shuto T, Takemura S, et al. Correlation between preoperative serum concentration of type IV collagen 7s domain and hepatic failure following resection of hepatocellular carcinoma. Ann Surg. 2004;239:186–93.
Wu CC, Ho WL, Yeh DC, Huang CR, Liu TJ. K. Hepatic resection of hepatocellular carcinoma in cirrhotic livers: is it unjustified in impaired liver function? Surgery. 1996;120:34–9.
Imamura H, Seyama Y, Kokudo N, Maema A, Sugawara Y, Sano K, et al. One thousand fifty-six hepatectomies without mortality in 8 years. Arch Surg. 2003;138:1198–206 (discussion 206).
Lau H, Man K, Fan ST, Yu WC, Lo CM, Wong J. Evaluation of preoperative hepatic function in patients with hepatocellular carcinoma undergoing hepatectomy. Br J Surg. 1997;84:1255–9.
Rodriguez-Diaz JL, Rosas-Camargo V, Vega-Vega O, Morales-Espinosa D, Mendez-Reguera A, Martinez-Tlahuel JL, et al. Clinical and pathological factors associated with the development of hepatocellular carcinoma in patients with hepatitis virus-related cirrhosis: a long-term follow-up study. Clin Oncol (R Coll Radiol). 2007;19:197–203.
Ha-Kawa SK, Tanaka Y, Hasebe S, Kuniyasu Y, Koizumi K, Ishii Y, et al. Compartmental analysis of asialoglycoprotein receptor scintigraphy for quantitative measurement of liver function: a multicentre study. Eur J Nucl Med. 1997;24:130–7.
Vauthey JN, Chaoui A, Do KA, Bilimoria MM, Fenstermacher MJ, Charnsangavej C, et al. Standardized measurement of the future liver remnant prior to extended liver resection: methodology and clinical associations. Surgery. 2000;127:512–9.
Yigitler C, Farges O, Kianmanesh R, Regimbeau JM, Abdalla EK, Belghiti J. The small remnant liver after major liver resection: how common and how relevant? Liver Transpl. 2003;9:S18–25.
Clavien PA, Emond J, Vauthey JN, Belghiti J, Chari RS, Strasberg SM. Protection of the liver during hepatic surgery. J Gastrointest Surg. 2004;8:313–27.
Strassburg CP. Gilbert–Meulengracht’s syndrome and pharmacogenetics: is jaundice just the tip of the iceberg? Drug Metab Rev. 2010;42:168–81.
Balzan S, Belghiti J, Farges O, Ogata S, Sauvanet A, Delefosse D, et al. The “50-50 criteria” on postoperative day 5: an accurate predictor of liver failure and death after hepatectomy. Ann Surg. 2005;242:824–8 (discussion 8–9).
Author information
Authors and Affiliations
Corresponding author
About this article
Cite this article
Masuda, T., Beppu, T., Nakagawa, S. et al. Assessment of safety in hepatic resection for hepatocellular carcinoma focusing on indirect hyperbilirubinemia. J Hepatobiliary Pancreat Sci 20, 370–374 (2013). https://doi.org/10.1007/s00534-012-0540-8
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00534-012-0540-8