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Ann Surg Treat Res. 2014 Mar;86(3):122-9. doi: 10.4174/astr.2014.86.3.122. Epub 2014 Feb 24.

Can the model for end-stage liver disease score replace the indocyanine green clearance test in the selection of right hemihepatectomy in Child-Pugh class A?

Author information

  • 1Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
  • 2Division of Gastroenterology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
  • 3Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Abstract

PURPOSE:

To identify the correlation of the model for end-stage liver disease (MELD) scores with the assessment of the risk of hepatic function after hemihepatectomy in patients with hepatocellular carcinoma (HCC) related to hepatitis B virus (HBV).

METHODS:

A case-control study was performed based on data for 141 consecutive patients who underwent curative right hepatic resection between January 2006 and June 2010.

RESULTS:

All patients were Child-Pugh class A. The mean age of the patients was 50 years (range, 29-73 years). The group included 114 men (80.9%) and 27 women (19.1%). The distribution of MELD scores (median, 7; range, 6-14) and indocyanine green retention rate at 15 minutes (ICG-R15) (median, 9.2%; range, 1.1%-19.5%) showed no significant correlation (P = 0.615). Only one perioperative death (0.7%) occurred within 30 days, which was the result of liver failure by hepatic artery dissection during the Pringle maneuver. Hepatic dysfunction occurred in 25 patients (17.7%) after liver resection. In multivariate analysis, male gender, increased HBV DNA level, and elevated serum aspartate transaminase level were significantly related with hepatic dysfunction. Tumor size and satellite nodule were closely associated with tumor recurrence in HBV-related HCC after right hemihepatectomy and satellite nodule was a predisposing factor for mortality in those patients.

CONCLUSION:

MELD score does not accurately predict hepatic function after right hemihepatectomy in patients with resectable HBV-related HCC. MELD scores were not correlated with the ICG-R15 values in patients with Child-Pugh class A.

KEYWORDS:

Hepatectomy; Hepatitis B virus; Hepatocellular carcinoma; Liver disease; Liver function test

PMID:
24761420
[PubMed]
PMCID:
PMC3994621
Free PMC Article

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