Management before hepatectomy for hepatocellular carcinoma with cirrhosis

Table 1 Prediction formula and discriminating factors for hepatic cirrhosis

Year	Ref.	Formula
2000	Ikeda et al[14]	Z = (0.124) × [γ globulin (%)] + (0.001) × hyaluronic acid (ng/mL) + (0.075) × platelet count (104/μL) + (-0.413) × gender (male = 1, female = 2) + (-2.005)
		The condition is hepatic cirrhosis when Z is positive, and chronic hepatitis when Z is negative
2007	Koda et al[15]	Fibroindex = (1.738) + (-0.064) × platelet count (104/μL) + (0.005) × AST (IU/L) + (0.463) × [γ globulin (g/dL)]
		The fibroindex value corresponds to fibrosis stage
2003	Wai et al[16]	APRI = 100 × [AST level/(upper limit of normal AST)/platelet count (× 109/L)]
2006	Sterling et al[17]	FIB-4 = [age × AST (U/L)]/[platelet count (× 109/L) × ALT (U/L)1/2]

APRI: AST to platelet ratio index; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; FIB-4: Fibroindex-4.

Table 2 Definitions of the cancer of the liver Italian program score[27]

Variable	Score
	0	1	2
Child-Pugh stage	A	B	C
Tumor morphology	Uninodular and extension ≤ 50%	Multinodular and extension ≤ 50%	Massive or extension > 50%
AFP (ng/mL)	< 400	≥ 400
Portal vein thrombosis	No	Yes

AFP: Alpha-fetoprotein.

Table 3 Definitions of the Japan integrated staging score[28]

Variable	0	1	2	3
Child-Pugh stage	A	B	C
TNM stage1	I	II	III	IV

¹By liver cancer study group of Japan.

Table 4 Reports on liver resection and splenectomy for hepatocellular carcinoma complicated by hepatic cirrhosis accompanied by hypersplenism

Year	Ref.	Simultaneous splenectomy, 2-stage (No. of patients)	Platelet count (×104/μL)	Child-Pugh (A/B/C)	Mortality	Morbidity	Survival rate	Effect
1989	Takayama et al[38]	Simultaneous (12), 2-stage (8)	4.6	N	N	N	N	Expansion of indication of liver resection
1999	Lin et al[94]	Simultaneous (11)	5.2 ± 1.5	5/6/0	9.1%	27.3%	5 yr recurrence-free 66.7%	Improvement of serum bilirubin level
2000	Sugawara et al[49]	Simultaneous (35), 2-stage (13)	4.7 ± 0.3	N	0	47.9	3/5 yr survival rate: 72.3%/38.9%	Improvement of safety
2000	Shimada et al[95]	2-stage (6)	5.2 ± 1.5	1/4/1	0	17	N	Improvement of platelet count, albumin level, and Child classification
2003	Oh et al[96]	Simultaneous (12), no sp (6)	5.5 ± 1.5	10/8/0	11.1	66.7	N	Expansion of indication of liver resection
2004	Wu et al[97]	Simultaneous (41), no sp (485)	3.8 ± 2.1	419/85/23	1.5	20.5	N	Improvement of recurrence-free survival rate
2005	Chen et al[98]	Simultaneous (94), no sp (110)	6.2	125/79/0	N	15.2	5 yr survival 56%, recurrence-free survival 35%	Improvement of recurrence-free survival rate
2008	Sugimachi et al[99]	Simultaneous (4), no sp (11)	4.2 ± 0.8	9/6/0	6.7	47	N	3-yr survival rate equivalent to that after conventional liver resection
2015	Zhang et al[100]	Simultaneous (84), no sp (84)	6.1 ± 4.2	84/0/0	0	39.3	1/3/5 yr survival: 90%/78%/66%	Improvement of recurrence-free survival rate

N: Details unknown.

Table 5 General rules for recording endoscopic findings of esophagogastric varices[50]

Category	Code subcategory
Location (L)	Ls: Locus superior
	Lm: Locus medialis
	Li: Locus inferior
	Lg-c: Adjacent to the cardiac orifice
	Lg-cf: Extension from the cardiac orifice to the fornix
	Lg-f: Isolated in the fornix
	Lg-b: Located in the gastric body
	Lg-a: Located in the gastric antrum
Form (F)	F0: No varicose appearance
	F1: Straight, small-caliber varices
	F2: Moderately enlarged, beady varices
	F3: Markedly enlarged, nodular or tumor-shaped varices
Color (C)	Cw: White varices
	Cb: Blue varices
	Cw-Th: Thrombosed white varices
	Cb-Th: Thrombosed blue varices
Red color signs (RC)	RWM: Red wale markings
	CRS: Cherry red spots
	HCS: Hematocystic spots
	Esophageal varices: RC0, RC1, RC2, RC3
	Gastric varices: RC0, RC1
	Te: Telangiectasia
Bleeding signs	Gushing bleeding
	Spurting bleeding
	Oozing bleeding
	Red plug
	White plug
Mucosal findings	E: Erosion
	Ul: Ulcer
	S: Scar

Table 6 McCormack classification for the presence of portal hypertension and portal hypertensive gastropathy[52]

Mild gastropathy	Fine pink speckling
	Superficial reddening
	Snakeskin (Mosaic-like) appearance
Severe gastropathy	Cherry-red spots
	Diffuse hemorrhagic lesion