Hepatological Evaluation and Biomarkers

Abstract

AbstractMost patients candidate to liver resection for hepatocellular carcinoma (HCC) have an underlying liver disease, often evolved into cirrhosis. The evaluation of liver function and portal hypertension is important to avoid postoperative liver failure and death. The presence of clinically significant portal hypertension (CSPH) is crucial for surgical decision-making and considered by many a criterion for exclusion, although the improvement of surgical techniques has allowed resective surgery even in the case of CSPH. The invasive measurement of portal hypertension represents the gold standard for assessing CSPH, but requires specific operator experience and it is not available in all hepatobiliary surgery centers. Noninvasive portal pressure measurement methods are promising techniques in preoperative assessment. The liver function also needs to be carefully evaluated, the model of end-stage liver disease (MELD) is the simplest and most validated method. Dynamic tests, such as the indocyanine green retention rate, have been widely used in Asia. Hepatological evaluation should help to stratify the risk of postoperative liver failure by using a hierarchical scale based on biochemical parameters of liver function and invasive/noninvasive portal pressure evaluation.KeywordsHepatocellular carcinomaPortal hypertensionLiver functionIndocyanine greenHepatic venous pressure gradient