Estimation of Functional Liver Reserve Using 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.

The records of approximately 245 consecutive patients who were referred at our Unit because of HCC were reviewed. Among those, 191 (78%) were submitted to surgery, and 181 (74%) were resected. The patients excluded from surgery were addressed to symptomatic treatments because of advanced disease or impaired liver functional reserve, or to percutaneous ablation therapy according to our policy. Among resected patients, there were 145 (80%) men and 36 (20%) women, with median age of 67 years (range 36-87 years).

• Hepatocellular Carcinoma
• Cirrhosis
• Liver Neoplasm
• Liver Disease

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