The ICG clearance test, which is relatively inexpensive and is one of the simpler factors for evaluating preoperative liver function, is often reported. However, there are not many reports with high evidence levels uniquely discussing factors

for evaluating preoperative liver function, and examinations including postoperative complications are also rarely conducted. In addition, the ICG clearance test may underrate hepatic functional reserve due to the presence of an intrahepatic Ibrutinib ic50 shunt or jaundice. From this perspective, none of the liver function assessment methods currently available can independently reveal accurate liver function, but they can evaluate just one aspect of liver function. Actually, a comprehensive assessment combining the results of these clearance tests with other routine data,

such as blood tests, imaging examinations and residual liver volume, is essential. Nonetheless, the ICG 15-min retention rate is widely used in the actual clinical setting as a factor for determining liver damage in the Makuuchi Criteria (LF018587 level 2b) or by the Liver Cancer Study Group of Japan AZD8055 manufacturer (LF120888), and it has contributed to markedly improved safety: the operative mortality in hepatocellular carcinoma patients is 0.8% in Japan (LF120899 level 2a). Under these circumstances, it is not realistic to reevaluate an assessment factor for preoperative liver function using postoperative death as an end-point. In the present situation, the ICG 15-min retention

rate is beneficial as an evaluation factor for preoperative liver function and, in particular, can serve as a predictor for postoperative death. CQ18 How should the extent of hepatectomy in patients with non-cirrhotic hepatocellular carcinoma be determined? Protirelin Major resection is not always necessary if curative resection is feasible. Limited resection may be sufficient according to liver function and tumor progression. (grade B) An article describing a study of patients with non-cirrhotic hepatocellular carcinoma comparing major resection and limited resection (LF002651 level 2b) showed no difference between the two procedures in the bleeding volume, complications, survival rate or recurrence-free survival rate. A study including cirrhotic patients (LF008852 level 2b) as well as a study only on hepatocellular carcinoma patients with cirrhosis (LF009923 level 2a) also revealed no difference in postoperative survival between the two.