Ann Surg Treat Res.  2014 Mar;86(3):122-129. 10.4174/astr.2014.86.3.122.

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?

• Kim JM
• Kwon CH
• Joh JW
• Park JB
• Lee JH
• Kim GS
• Kim SJ
• Paik SW

• KMID: 2266892
• DOI: http://doi.org/10.4174/astr.2014.86.3.122

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.

Keyword

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

MeSH Terms

Aspartate Aminotransferases
Carcinoma, Hepatocellular
Case-Control Studies
Causality
DNA
Female
Hepatectomy
Hepatic Artery
Hepatitis B virus
Humans
Indocyanine Green*
Liver Diseases*
Liver Failure
Liver Function Tests
Liver*
Male
Mortality
Multivariate Analysis
Recurrence
Aspartate Aminotransferases
DNA
Indocyanine Green

Figure

• 

  Fig. 1 ICG-R15 and MELD scores prior to right hemihepatectomy showed no correlation in patients with HBV-related HCC (r = 0.044, P = 0.615). ICG-R15, indocyanine green retention rate at 15 minutes; MELD, model for end-stage liver disease.

• 

  Fig. 2 Cumulative disease-free survival (A) and overall survival (B) in patients after right hemihepatectomy.

Reference

1. Pugh RN, Murray-Lyon IM, Dawson JL, Pietroni MC, Williams R. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg. 1973; 60:646–649.

2. Kamath PS, Wiesner RH, Malinchoc M, Kremers W, Therneau TM, Kosberg CL, et al. A model to predict survival in patients with end-stage liver disease. Hepatology. 2001; 33:464–470.

3. Makuuchi M, Kosuge T, Takayama T, Yamazaki S, Kakazu T, Miyagawa S, et al. Surgery for small liver cancers. Semin Surg Oncol. 1993; 9:298–304.

4. Schneider PD. Preoperative assessment of liver function. Surg Clin North Am. 2004; 84:355–373.

5. Edmondson HA, Steiner PE. Primary carcinoma of the liver: a study of 100 cases among 48,900 necropsies. Cancer. 1954; 7:462–503.

6. Shah SA, Cleary SP, Wei AC, Yang I, Taylor BR, Hemming AW, et al. Recurrence after liver resection for hepatocellular carcinoma: risk factors, treatment, and outcomes. Surgery. 2007; 141:330–339.

7. 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; 138:1198–1206.

8. Chijiiwa K, Watanabe M, Nakano K, Noshiro H, Tanaka M. Biliary indocyanine green excretion as a predictor of hepatic adenosine triphosphate levels in patients with obstructive jaundice. Am J Surg. 2000; 179:161–166.

9. Hsieh CB, Chen CJ, Chen TW, Yu JC, Shen KL, Chang TM, et al. Accuracy of indocyanine green pulse spectrophotometry clearance test for liver function prediction in transplanted patients. World J Gastroenterol. 2004; 10:2394–2396.

10. Seyama Y, Kokudo N. Assessment of liver function for safe hepatic resection. Hepatol Res. 2009; 39:107–116.

11. Mullin EJ, Metcalfe MS, Maddern GJ. How much liver resection is too much? Am J Surg. 2005; 190:87–97.

12. Lam CM, Fan ST, Lo CM, Wong J. Major hepatectomy for hepatocellular carcinoma in patients with an unsatisfactory indocyanine green clearance test. Br J Surg. 1999; 86:1012–1017.

13. Wiesner R, Edwards E, Freeman R, Harper A, Kim R, Kamath P, et al. Model for end-stage liver disease (MELD) and allocation of donor livers. Gastroenterology. 2003; 124:91–96.

14. Botta F, Giannini E, Romagnoli P, Fasoli A, Malfatti F, Chiarbonello B, et al. MELD scoring system is useful for predicting prognosis in patients with liver cirrhosis and is correlated with residual liver function: a European study. Gut. 2003; 52:134–139.

15. Befeler AS, Palmer DE, Hoffman M, Longo W, Solomon H, Di Bisceglie AM. The safety of intra-abdominal surgery in patients with cirrhosis: model for end-stage liver disease score is superior to Child-Turcotte-Pugh classification in predicting outcome. Arch Surg. 2005; 140:650–654.

16. Delis SG, Bakoyiannis A, Dervenis C, Tassopoulos N. Perioperative risk assessment for hepatocellular carcinoma by using the MELD score. J Gastrointest Surg. 2009; 13:2268–2275.

17. Teh SH, Christein J, Donohue J, Que F, Kendrick M, Farnell M, et al. Hepatic resection of hepatocellular carcinoma in patients with cirrhosis: Model of End-Stage Liver Disease (MELD) score predicts perioperative mortality. J Gastrointest Surg. 2005; 9:1207–1215.

18. Cucchetti A, Ercolani G, Cescon M, Ravaioli M, Zanello M, Del Gaudio M, et al. Recovery from liver failure after hepatectomy for hepatocellular carcinoma in cirrhosis: meaning of the model for end-stage liver disease. J Am Coll Surg. 2006; 203:670–676.

19. Schroeder RA, Marroquin CE, Bute BP, Khuri S, Henderson WG, Kuo PC. Predictive indices of morbidity and mortality after liver resection. Ann Surg. 2006; 243:373–379.

20. Teh SH, Sheppard BC, Schwartz J, Orloff SL. Model for end-stage liver disease score fails to predict perioperative outcome after hepatic resection for hepatocellular carcinoma in patients without cirrhosis. Am J Surg. 2008; 195:697–701.