Preoperative assessment of liver function

Deaths from hepatic failure after liver resection have been limited by selecting Child Class A patients, based on a determination of Child-Pugh scores, indocyanine green (ICG) retention testing, and knowledgeable assessment of the degree of coexisting liver disease. By adjusting the extent of resection to the concomitant need for an adequate resection margin, and maintenance of an adequate functional reserve after resection, postoperative morbidity and mortality will be optimized. A new functional scintigraphy test using 99m-Tc-galactosyl human serum albumin may augment clinical decision making in the future. In view of current excellent results with patient selection for hepatic resection, future studies of this agent must focus on clinical outcomes in a large number of resected patients.