Prediction of the risk of hepatic failure in patients with portal vein invasion hepatoma after hepatic resection

Aim: Hepatic failure can develop after curative hepatectomy in patients with a hepatocellular carcinoma (HCC) invading the portal vein, because of cirrhosis and excessive tissue loss. This study aimed to identify the risk factors for hepatic failure in such patients. Method: Forty patients with an HCC invading the portal vein underwent curative hepatectomy from January 1995 to June 2003. Eight patients developed hepatic failure and died within 3 months. Possible risk factors for this were analysed using univariate and multivariate regression. These included the liver function index, surgical blood loss, tumour pattern, portal hypertension, estimated residual liver volume measured by computed tomography (ERLV_CT) and estimated residual liver volume using the indocyanine green (ICG) retention rate at 15 min (ERLV_ICG15). Results: The ERLV_CT smaller than the ERLV_ICG15 and presence of portal hypertension were independent risk factors for post-hepatectomy hepatic failure. Conclusion: Having portal vein invasion HCC with portal hypertension or an ERLV_CT less than an ERLV_ICG15 are significant predictors of post-hepatectomy hepatic failure. These factors are important considerations for patients with portal vein invasion HCC who could undergo curative hepatic resection.