Assessment of preoperative liver function in patients undergoing liver resection – The ALICE grade

Abstract

Objective: Precise preoperative evaluation of the patient's liver function is essential for surgical decision making in patients with hepatocellular carcinoma (HCC) and colorectal liver metastasis (CRLM). The aim of the study is to validate the usefulness of the new preoperative liver function evaluation system, Albumin-Indocyanine Green Evaluation (ALICE) grading system, for predicting the postoperative outcomes after liver resection in both HCC and CRLM patients. Methods: The ALICE grading system, incorporating only serum albumin level and the indocyanine green retention rate at 15 minutes (ICG R15), was developed based on the overall survival of 1868 HCC patients: linear predictor = 0.663 × log10ICG R15 (%) - 0.0718 × albumin (g/L) (cut-off value: -2.20 and -1.39). We analyzed the predictive power for the postoperative short-term outcome after liver resection in 1025 patients with HCC and 348 patients with CRLM. Results: Determination of the ALICE grade allowed better prediction of the risk of postoperative liver failure than the previously reported model based on the presence/absence of portal hypertension (PH). A combination of ALICE grade and PH further predicted the risk of postoperative liver failure. Determination of the ALICE grade also allowed prediction of the risk of postoperative complications and ascites in patients with CRLM, which was also significant in multivariate analysis. Pathological examination revealed chemotherapy related liver damage in high ALICE grade CRLM patients. Conclusions: This new grading system is a simple method for prediction of the postoperative short-term outcomes in both HCC and CRLM patients.