Advances in preoperative assessment of liver functional reserve in patients with hepatocellular carcinoma_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

XIE Wenyuan ,  LUO Shiqiao

Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400010, P. R. China;

Corresponding author：

LUO Shiqiao, Email: shiqiaoluo@qq.com

Keywords：

liver function reserve; hepatocellular carcinoma; post-hepatectomy liver failure; review

DOI：

10.7507/1007-9424.202208036

Video：

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Objective To introduce the basic principles of commonly used assessment methods for liver function reserve, and compare the advantages and disadvantages of various assessment methods, so as to provide a reference for hepatectomy of patients with hepatocellular carcinoma (HCC). Method The literature on evaluation methods of liver reserve function in patients with HCC at home and abroad in recent years was searched and summarized. Results From the results of literature review, the Child‐Pugh score and indocyanine green discharge test were the most commonly used to assess preoperative liver function reserve for patients with HCC. The application value of other examinations such as albumin-bilirubin score, gadolinium-ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (Gd-EOB-DTPA-enhanced MRI), nuclear medical imaging in predicting post-hepatectomy liver failure was gradually being explored. Conclusions The combination of clinical parameters and volumetric studies is used to assess preoperative liver function reserve for patients with HCC. The clinical applications of nuclear medical imaging and Gd-EOB-DTPA-enhanced MRI make up for the deficiency of local liver function reserve evaluation, which are important examinations to assess liver function reserve after conversion therapy in the future. However, more domestic studies are still needed to confirm their values.

Citation： XIE Wenyuan, LUO Shiqiao. Advances in preoperative assessment of liver functional reserve in patients with hepatocellular carcinoma. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2023, 30(1): 115-122. doi: 10.7507/1007-9424.202208036 Copy

1.	Pugh RN, Murray-Lyon IM, Dawson JL, et al. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg, 1973, 60(8): 646-649.
2.	Malinchoc M, Kamath PS, Gordon FD, et al. A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts. Hepatology, 2000, 31(4): 864-871.
3.	Cucchetti A, Ercolani G, Vivarelli M, et al. Impact of model for end-stage liver disease (MELD) score on prognosis after hepatectomy for hepatocellular carcinoma on cirrhosis. Liver Transpl, 2006, 12(6): 966-971.
4.	Reddy SS, Civan JM. From Child-Pugh to Model for End-Stage Liver Disease: deciding who needs a liver transplant. Med Clin North Am, 2016, 100(3): 449-464.
5.	Biggins SW, Kim WR, Terrault NA, et al. Evidence-based incorporation of serum sodium concentration into MELD. Gastroenterology, 2006, 130(6): 1652-1660.
6.	Cholankeril G, Li AA, Dennis BB, et al. Pre-operative delta-MELD is an independent predictor of higher mortality following liver transplantation. Sci Rep, 2019, 9(1): 8312. doi: 10.1038/s41598-019-44814-y.
7.	Johnson PJ, Berhane S, Kagebayashi C, et al. Assessment of liver function in patients with hepatocellular carcinoma: a new evidence-based approach-the ALBI grade. J Clin Oncol, 2015, 33(6): 550-558.
8.	Starlinger P, Ubl DS, Hackl H, et al. Combined APRI/ALBI score to predict mortality after hepatic resection. BJS Open, 2021, 5(1): zraa043. doi: 10.1093/bjsopen/zraa043.
9.	Hiraoka A, Kumada T, Michitaka K, et al. Newly proposed ALBI grade and ALBI-T score as tools for assessment of hepatic function and prognosis in hepatocellular carcinoma patients. Liver Cancer, 2019, 8(5): 312-325.
10.	Kariyama K, Nouso K, Hiraoka A, et al. EZ-ALBI score for predicting hepatocellular carcinoma prognosis. Liver Cancer, 2020, 9(6): 734-743.
11.	Wang YY, Zhong JH, Su ZY, et al. Albumin-bilirubin versus Child-Pugh score as a predictor of outcome after liver resection for hepatocellular carcinoma. Br J Surg, 2016, 103(6): 725-734.
12.	Zou H, Yang X, Li QL, et al. A comparative study of albumin-bilirubin score with Child-Pugh score, model for end-stage liver disease score and indocyanine green R15 in predicting posthepatectomy liver failure for hepatocellular carcinoma patients. Dig Dis, 2018, 36(3): 236-243.
13.	Wang YY, Zhao XH, Ma L, et al. Comparison of the ability of Child-Pugh score, MELD score, and ICG-R15 to assess preoperative hepatic functional reserve in patients with hepatocellular carcinoma. J Surg Oncol, 2018, 118(3): 440-445.
14.	Zhang ZQ, Xiong L, Zhou JJ, et al. Ability of the ALBI grade to predict posthepatectomy liver failure and long-term survival after liver resection for different BCLC stages of HCC. World J Surg Oncol, 2018, 16(1): 208. doi: 10.1186/s12957-018-1500-9.
15.	Fagenson AM, Gleeson EM, Pitt HA, et al. Albumin-Bilirubin score vs model for end-stage liver disease in predicting post-hepatectomy outcomes. J Am Coll Surg, 2020, 230(4): 637-645.
16.	Anger F, Klein I, Löb S, et al. Preoperative liver function guiding HCC resection in normal and cirrhotic liver. Visc Med, 2021, 37(2): 94-101.
17.	Fu R, Qiu T, Ling W, et al. Comparison of preoperative two-dimensional shear wave elastography, indocyanine green clearance test and biomarkers for post hepatectomy liver failure prediction in patients with hepatocellular carcinoma. BMC Gastroenterol, 2021, 21(1): 142. doi: 10.1186/s12876-021-01727-3.
18.	Wen X, Yao M, Lu Y, et al. Integration of prealbumin into Child-Pugh classification improves prognosis predicting accuracy in HCC patients considering curative surgery. J Clin Transl Hepatol, 2018, 6(4): 377-384.
19.	Ingenbleek Y. Plasma transthyretin as a biomarker of sarcopenia in elderly subjects. Nutrients, 2019, 11(4): 895. doi: 10.3390/nu11040895.
20.	Makuuchi M, Kosuge T, Takayama T, et al. Surgery for small liver cancers. Semin Surg Oncol, 1993, 9(4): 298-304.
21.	Köller A, Grzegorzewski J, König M. Physiologically based modeling of the effect of physiological and anthropometric variability on indocyanine green based liver function tests. Front Physiol, 2021, 12: 757293. doi: 10.3389/fphys.2021.757293.
22.	Paumgartner G, Huber J, Grabner G. Kinetics of hepatic dye absorption for indocyanine green. Influence of bilirubin and sodium glycocholate. Experientia, 1969, 25(11): 1219-1223.
23.	Liu W, Chen LJ, Jiang Y, et al. Hepatocellular carcinoma with indocyanine green excretory defect: a case report and review of the literature. J Int Med Res, 2021, 49(4): 3000605211004025. doi: 10.1177/03000605211004025.
24.	Kokudo T, Hasegawa K, Amikura K, et al. Assessment of preoperative liver function in patients with hepatocellular carcinoma—the albumin-indocyanine green evaluation (ALICE) grade. PLoS One, 2016, 11(7): e0159530. doi: 10.1371/journal.pone.0159530.
25.	Stockmann M, Lock JF, Riecke B, et al. Prediction of postoperative outcome after hepatectomy with a new bedside test for maximal liver function capacity. Ann Surg, 2009, 250(1): 119-125.
26.	Gorowska-Kowolik K, Chobot A, Kwiecien J. ¹³C methacetin breath test for assessment of microsomal liver function: methodology and clinical application. Gastroenterol Res Pract, 2017, 2017: 7397840. doi: 10.1155/2017/7397840.
27.	Dziodzio T, Öllinger R, Schöning W, et al. Validation of a new prognostic model to predict short and medium-term survival in patients with liver cirrhosis. BMC Gastroenterol, 2020, 20(1): 265. doi: 10.1186/s12876-020-01407-8.
28.	Jara M, Dziodzio T, Malinowski M, et al. Prospective assessment of liver function by an enzymatic liver function test to estimate short-term survival in patients with liver cirrhosis. Dig Dis Sci, 2019, 64(2): 576-584.
29.	de Graaf W, Häusler S, Heger M, et al. Transporters involved in the hepatic uptake of ^99mTc-mebrofenin and indocyanine green. J Hepatol, 2011, 54(4): 738-745.
30.	Heyman S. Hepatobiliary scintigraphy as a liver function test. J Nucl Med, 1994, 35(3): 436-437.
31.	Hoekstra LT, de Graaf W, Nibourg GA, et al. Physiological and biochemical basis of clinical liver function tests: a review. Ann Surg, 2013, 257(1): 27-36.
32.	Olthof PB, Coelen RJS, Bennink RJ, et al. ^99mTc-mebrofenin hepatobiliary scintigraphy predicts liver failure following major liver resection for perihilar cholangiocarcinoma. HPB (Oxford), 2017, 19(10): 850-858.
33.	Iimuro Y, Kashiwagi T, Yamanaka J, et al. Preoperative estimation of asialoglycoprotein receptor expression in the remnant liver from CT/^99mTc-GSA SPECT fusion images correlates well with postoperative liver function parameters. J Hepatobiliary Pancreat Sci, 2010, 17(5): 673-681.
34.	Noji T, Inoue A, Nakanishi Y, et al. ^99mTc-GSA scintigraphy could predict post-hepatectomy liver failure-related death in biliary surgery. J Gastrointest Surg, 2021, 25(12): 3236-3238.
35.	Tomita K, Chiba N, Ochiai S, et al. Prognostic value of future liver remnant LU15 index of ^99mTc-galactosyl serum albumin scintigraphy for predicting posthepatectomy liver failure. PLoS One, 2021, 16(2): e0247675. doi: 10.1371/journal.pone.0247675.
36.	王荣福, 庞小溪, 刘敏, 等. ^99mTc-GSA肝受体显像在肝功能评估临床研究应用及进展. 世界华人消化杂志, 2017, 25(21): 1903-1909.
37.	Gennisson JL, Deffieux T, Fink M, et al. Ultrasound elastography: principles and techniques. Diagn Interv Imaging, 2013, 94(5): 487-495.
38.	Dietrich CF, Bamber J, Berzigotti A, et al. EFSUMB guidelines and recommendations on the clinical use of liver ultrasound elastography, update 2017 (Long version). Ultraschall Med, 2017, 38(4): e16-e47. doi: 10.1055/s-0043-103952.
39.	Shen Y, Zhou C, Zhu G, et al. Liver stiffness assessed by shear wave elastography predicts postoperative liver failure in patients with hepatocellular carcinoma. J Gastrointest Surg, 2017, 21(9): 1471-1479.
40.	Rajakannu M, Cherqui D, Ciacio O, et al. Liver stiffness measurement by transient elastography predicts late posthepatectomy outcomes in patients undergoing resection for hepatocellular carcinoma. Surgery, 2017, 162(4): 766-774.
41.	Ferraioli G, Filice C, Castera L, et al. WFUMB guidelines and recommendations for clinical use of ultrasound elastography: Part 3: liver. Ultrasound Med Biol, 2015, 41(5): 1161-1179.
42.	Tang A, Cloutier G, Szeverenyi NM, et al. Ultrasound elastography and MR elastography for assessing liver fibrosis: Part 1, principles and techniques. AJR Am J Roentgenol, 2015, 205(1): 22-32.
43.	Long H, Xu W, Zhong X, et al. Feasibility of liver stiffness measured using two-dimensional shear wave elastography in assessing preoperative liver function for patients with hepatocellular carcinoma. Abdom Radiol (NY), 2022, 47(2): 664-671.
44.	Luo N, Huang X, Ji Y, et al. A functional liver imaging score for preoperative prediction of liver failure after hepatocellular carcinoma resection. Eur Radiol, 2022, 32(8): 5623-5632.
45.	Park HJ, Yoon JS, Lee SS, et al. Deep learning-based assessment of functional liver capacity using gadoxetic acid-enhanced hepatobiliary phase MRI. Korean J Radiol, 2022, 23(7): 720-731.
46.	Mise Y, Hasegawa K, Satou S, et al. How has virtual hepatectomy changed the practice of liver surgery?: experience of 1 194 virtual hepatectomy before liver resection and living donor liver transplantation. Ann Surg, 2018, 268(1): 127-133.
47.	Orimo T, Kamiyama T, Kamachi H, et al. Predictive value of gadoxetic acid enhanced magnetic resonance imaging for posthepatectomy liver failure after a major hepatectomy. J Hepatobiliary Pancreat Sci, 2020, 27(8): 531-540.
48.	Lefebvre T, Wartelle-Bladou C, Wong P, et al. Prospective comparison of transient, point shear wave, and magnetic resonance elastography for staging liver fibrosis. Eur Radiol, 2019, 29(12): 6477-6488.
49.	Huang M, Shen S, Cai H, et al. Regional liver function analysis with gadoxetic acid-enhanced MRI and virtual hepatectomy: prediction of postoperative short-term outcomes for HCC. Eur Radiol, 2021, 31(7): 4720-4730.
50.	Bertens KA, Hawel J, Lung K, et al. ALPPS: challenging the concept of unresectability—a systematic review. Int J Surg, 2015, 13: 280-287.

1. Pugh RN, Murray-Lyon IM, Dawson JL, et al. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg, 1973, 60(8): 646-649.
2. Malinchoc M, Kamath PS, Gordon FD, et al. A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts. Hepatology, 2000, 31(4): 864-871.
3. Cucchetti A, Ercolani G, Vivarelli M, et al. Impact of model for end-stage liver disease (MELD) score on prognosis after hepatectomy for hepatocellular carcinoma on cirrhosis. Liver Transpl, 2006, 12(6): 966-971.
4. Reddy SS, Civan JM. From Child-Pugh to Model for End-Stage Liver Disease: deciding who needs a liver transplant. Med Clin North Am, 2016, 100(3): 449-464.
5. Biggins SW, Kim WR, Terrault NA, et al. Evidence-based incorporation of serum sodium concentration into MELD. Gastroenterology, 2006, 130(6): 1652-1660.
6. Cholankeril G, Li AA, Dennis BB, et al. Pre-operative delta-MELD is an independent predictor of higher mortality following liver transplantation. Sci Rep, 2019, 9(1): 8312. doi: 10.1038/s41598-019-44814-y.
7. Johnson PJ, Berhane S, Kagebayashi C, et al. Assessment of liver function in patients with hepatocellular carcinoma: a new evidence-based approach-the ALBI grade. J Clin Oncol, 2015, 33(6): 550-558.
8. Starlinger P, Ubl DS, Hackl H, et al. Combined APRI/ALBI score to predict mortality after hepatic resection. BJS Open, 2021, 5(1): zraa043. doi: 10.1093/bjsopen/zraa043.
9. Hiraoka A, Kumada T, Michitaka K, et al. Newly proposed ALBI grade and ALBI-T score as tools for assessment of hepatic function and prognosis in hepatocellular carcinoma patients. Liver Cancer, 2019, 8(5): 312-325.
10. Kariyama K, Nouso K, Hiraoka A, et al. EZ-ALBI score for predicting hepatocellular carcinoma prognosis. Liver Cancer, 2020, 9(6): 734-743.
11. Wang YY, Zhong JH, Su ZY, et al. Albumin-bilirubin versus Child-Pugh score as a predictor of outcome after liver resection for hepatocellular carcinoma. Br J Surg, 2016, 103(6): 725-734.
12. Zou H, Yang X, Li QL, et al. A comparative study of albumin-bilirubin score with Child-Pugh score, model for end-stage liver disease score and indocyanine green R15 in predicting posthepatectomy liver failure for hepatocellular carcinoma patients. Dig Dis, 2018, 36(3): 236-243.
13. Wang YY, Zhao XH, Ma L, et al. Comparison of the ability of Child-Pugh score, MELD score, and ICG-R15 to assess preoperative hepatic functional reserve in patients with hepatocellular carcinoma. J Surg Oncol, 2018, 118(3): 440-445.
14. Zhang ZQ, Xiong L, Zhou JJ, et al. Ability of the ALBI grade to predict posthepatectomy liver failure and long-term survival after liver resection for different BCLC stages of HCC. World J Surg Oncol, 2018, 16(1): 208. doi: 10.1186/s12957-018-1500-9.
15. Fagenson AM, Gleeson EM, Pitt HA, et al. Albumin-Bilirubin score vs model for end-stage liver disease in predicting post-hepatectomy outcomes. J Am Coll Surg, 2020, 230(4): 637-645.
16. Anger F, Klein I, Löb S, et al. Preoperative liver function guiding HCC resection in normal and cirrhotic liver. Visc Med, 2021, 37(2): 94-101.
17. Fu R, Qiu T, Ling W, et al. Comparison of preoperative two-dimensional shear wave elastography, indocyanine green clearance test and biomarkers for post hepatectomy liver failure prediction in patients with hepatocellular carcinoma. BMC Gastroenterol, 2021, 21(1): 142. doi: 10.1186/s12876-021-01727-3.
18. Wen X, Yao M, Lu Y, et al. Integration of prealbumin into Child-Pugh classification improves prognosis predicting accuracy in HCC patients considering curative surgery. J Clin Transl Hepatol, 2018, 6(4): 377-384.
19. Ingenbleek Y. Plasma transthyretin as a biomarker of sarcopenia in elderly subjects. Nutrients, 2019, 11(4): 895. doi: 10.3390/nu11040895.
20. Makuuchi M, Kosuge T, Takayama T, et al. Surgery for small liver cancers. Semin Surg Oncol, 1993, 9(4): 298-304.
21. Köller A, Grzegorzewski J, König M. Physiologically based modeling of the effect of physiological and anthropometric variability on indocyanine green based liver function tests. Front Physiol, 2021, 12: 757293. doi: 10.3389/fphys.2021.757293.
22. Paumgartner G, Huber J, Grabner G. Kinetics of hepatic dye absorption for indocyanine green. Influence of bilirubin and sodium glycocholate. Experientia, 1969, 25(11): 1219-1223.
23. Liu W, Chen LJ, Jiang Y, et al. Hepatocellular carcinoma with indocyanine green excretory defect: a case report and review of the literature. J Int Med Res, 2021, 49(4): 3000605211004025. doi: 10.1177/03000605211004025.
24. Kokudo T, Hasegawa K, Amikura K, et al. Assessment of preoperative liver function in patients with hepatocellular carcinoma—the albumin-indocyanine green evaluation (ALICE) grade. PLoS One, 2016, 11(7): e0159530. doi: 10.1371/journal.pone.0159530.
25. Stockmann M, Lock JF, Riecke B, et al. Prediction of postoperative outcome after hepatectomy with a new bedside test for maximal liver function capacity. Ann Surg, 2009, 250(1): 119-125.
26. Gorowska-Kowolik K, Chobot A, Kwiecien J. ¹³C methacetin breath test for assessment of microsomal liver function: methodology and clinical application. Gastroenterol Res Pract, 2017, 2017: 7397840. doi: 10.1155/2017/7397840.
27. Dziodzio T, Öllinger R, Schöning W, et al. Validation of a new prognostic model to predict short and medium-term survival in patients with liver cirrhosis. BMC Gastroenterol, 2020, 20(1): 265. doi: 10.1186/s12876-020-01407-8.
28. Jara M, Dziodzio T, Malinowski M, et al. Prospective assessment of liver function by an enzymatic liver function test to estimate short-term survival in patients with liver cirrhosis. Dig Dis Sci, 2019, 64(2): 576-584.
29. de Graaf W, Häusler S, Heger M, et al. Transporters involved in the hepatic uptake of ^99mTc-mebrofenin and indocyanine green. J Hepatol, 2011, 54(4): 738-745.
30. Heyman S. Hepatobiliary scintigraphy as a liver function test. J Nucl Med, 1994, 35(3): 436-437.
31. Hoekstra LT, de Graaf W, Nibourg GA, et al. Physiological and biochemical basis of clinical liver function tests: a review. Ann Surg, 2013, 257(1): 27-36.
32. Olthof PB, Coelen RJS, Bennink RJ, et al. ^99mTc-mebrofenin hepatobiliary scintigraphy predicts liver failure following major liver resection for perihilar cholangiocarcinoma. HPB (Oxford), 2017, 19(10): 850-858.
33. Iimuro Y, Kashiwagi T, Yamanaka J, et al. Preoperative estimation of asialoglycoprotein receptor expression in the remnant liver from CT/^99mTc-GSA SPECT fusion images correlates well with postoperative liver function parameters. J Hepatobiliary Pancreat Sci, 2010, 17(5): 673-681.
34. Noji T, Inoue A, Nakanishi Y, et al. ^99mTc-GSA scintigraphy could predict post-hepatectomy liver failure-related death in biliary surgery. J Gastrointest Surg, 2021, 25(12): 3236-3238.
35. Tomita K, Chiba N, Ochiai S, et al. Prognostic value of future liver remnant LU15 index of ^99mTc-galactosyl serum albumin scintigraphy for predicting posthepatectomy liver failure. PLoS One, 2021, 16(2): e0247675. doi: 10.1371/journal.pone.0247675.
36. 王荣福, 庞小溪, 刘敏, 等. ^99mTc-GSA肝受体显像在肝功能评估临床研究应用及进展. 世界华人消化杂志, 2017, 25(21): 1903-1909.
37. Gennisson JL, Deffieux T, Fink M, et al. Ultrasound elastography: principles and techniques. Diagn Interv Imaging, 2013, 94(5): 487-495.
38. Dietrich CF, Bamber J, Berzigotti A, et al. EFSUMB guidelines and recommendations on the clinical use of liver ultrasound elastography, update 2017 (Long version). Ultraschall Med, 2017, 38(4): e16-e47. doi: 10.1055/s-0043-103952.
39. Shen Y, Zhou C, Zhu G, et al. Liver stiffness assessed by shear wave elastography predicts postoperative liver failure in patients with hepatocellular carcinoma. J Gastrointest Surg, 2017, 21(9): 1471-1479.
40. Rajakannu M, Cherqui D, Ciacio O, et al. Liver stiffness measurement by transient elastography predicts late posthepatectomy outcomes in patients undergoing resection for hepatocellular carcinoma. Surgery, 2017, 162(4): 766-774.
41. Ferraioli G, Filice C, Castera L, et al. WFUMB guidelines and recommendations for clinical use of ultrasound elastography: Part 3: liver. Ultrasound Med Biol, 2015, 41(5): 1161-1179.
42. Tang A, Cloutier G, Szeverenyi NM, et al. Ultrasound elastography and MR elastography for assessing liver fibrosis: Part 1, principles and techniques. AJR Am J Roentgenol, 2015, 205(1): 22-32.
43. Long H, Xu W, Zhong X, et al. Feasibility of liver stiffness measured using two-dimensional shear wave elastography in assessing preoperative liver function for patients with hepatocellular carcinoma. Abdom Radiol (NY), 2022, 47(2): 664-671.
44. Luo N, Huang X, Ji Y, et al. A functional liver imaging score for preoperative prediction of liver failure after hepatocellular carcinoma resection. Eur Radiol, 2022, 32(8): 5623-5632.
45. Park HJ, Yoon JS, Lee SS, et al. Deep learning-based assessment of functional liver capacity using gadoxetic acid-enhanced hepatobiliary phase MRI. Korean J Radiol, 2022, 23(7): 720-731.
46. Mise Y, Hasegawa K, Satou S, et al. How has virtual hepatectomy changed the practice of liver surgery?: experience of 1 194 virtual hepatectomy before liver resection and living donor liver transplantation. Ann Surg, 2018, 268(1): 127-133.
47. Orimo T, Kamiyama T, Kamachi H, et al. Predictive value of gadoxetic acid enhanced magnetic resonance imaging for posthepatectomy liver failure after a major hepatectomy. J Hepatobiliary Pancreat Sci, 2020, 27(8): 531-540.
48. Lefebvre T, Wartelle-Bladou C, Wong P, et al. Prospective comparison of transient, point shear wave, and magnetic resonance elastography for staging liver fibrosis. Eur Radiol, 2019, 29(12): 6477-6488.
49. Huang M, Shen S, Cai H, et al. Regional liver function analysis with gadoxetic acid-enhanced MRI and virtual hepatectomy: prediction of postoperative short-term outcomes for HCC. Eur Radiol, 2021, 31(7): 4720-4730.
50. Bertens KA, Hawel J, Lung K, et al. ALPPS: challenging the concept of unresectability—a systematic review. Int J Surg, 2015, 13: 280-287.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Advances in preoperative assessment of liver functional reserve in patients with hepatocellular carcinoma

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