Estimation of Functional Liver Reserve Using Cholinesterases

Estimation of Functional Liver Reserve in Patients With Hepatocellular Carcinoma in Cirrhosis: the Value of Preoperative Cholinesterases

Estimation of functional liver reserve in patients with hepatocellular carcinoma (HCC) in cirrhosis is of paramount importance to properly select candidates for surgical resection. Together with the value of bilirubin, the presence/absence of ascites and esophageal varices, and the rate of residual liver volume, which are our current parameters to measure functional liver reserve, the investigators sought to investigate the value of preoperative cholinesterases (CHE) in predict postoperative adverse outcome after hepatic resection for HCC.

Inclusion Criteria:

1. Total bilirubin < 2 mg/dl

2. No ascites

3. No esophageal varices, or esophageal varices eradicated by endoscopy

4. Liver volume:

   • residual liver volume > or = 40% if total bilirubin < 1 mg/dl
   • residual liver volume > or = 50% if total bilirubin between 1 and 1.5 mg/dl
   • only limited resection if total bilirubin > 1.5 mg/dl

5. Portal vein embolization was selected in any case in whom RLV did not fit the previous requirements.

Exclusion Criteria:

1. Total bilirubin > 2 mg/dl
2. Refractory ascites
3. Esophageal varices