Abstract
Approximately 20 years ago, using Child's criteria I pointed out that theindication for hepatic resection in cirrhotic patients was remarkably limited. In the present study, the preoperativeestimation of operative risk and the possibility of extending operative indications for heaptic surgery wereinvestigated, according to the clinical results for 469 patients with liver diseases who visited our clinic for about 13years. 1) Limitation in hepatectomy: The patients with a total risk of 4 calculated by various liver function tests or ICG Rmax of the remnant liver of 0.2-0.4 were at the limit of hepatectomy. Other factors influencing prognosisshould be considered, such as histological findings of active hepatitis and HBV infection, disturbances in thecoagulation-fibrinolysis system, poor nutritional status, hemodynamic changes in the liver during surgery and changes in cardiac, respiratory and renal functions. 2) Management of poor risk patients and surgical results: Recently, even the critically ill patients with severely impaired liver functions have been albe to undergo hepatic resection withthe extension of surgical indications, achieving a good long-term outcome with intensive care before andafter surgery, and introduction of the following management procedures: (1) partial splenic embolization for thepatients with severe functional disturbances in the coagulation-fibrinolysis system, (2) aggressive nutritionalsupport with BCAA administration, (3) maintenance of hepatic blood flow by infusion of PGE1, etc. Our experimentaltrials for extending the operative indications and extended hepatectomy are also described.
