The Surgical clinics of North America
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At the present time, the decision to resect and the choice of the extent ofa hepatic resection are largely based on surgical judgment. The CP score is the best assessment tool we can now employ. There is uniform agreement that even segmental resections are not possible in the vast majority of Child Class B patients, CP score 7 to 9. ⋯ For hepatocellular carcinoma or metastasis in cirrhotic patients, portal vein occlusion may be the best way to improve hepatic functional reserve. ICG retention may not corroborate return-to-baseline hepatic function within 2 weeks of portal vein occlusion,but may demonstrate a return to baseline when studied 6 to 8 weeks following the procedure. 99m-Tc-GSA is presently the best means to document compensatory hyperplasia and, possibly, a shift of functional reserve to the planned remnant of a more than four-segment hepatic resection. Whether this will predict the safe outcome of resection remains to be seen.