Management before hepatectomy for hepatocellular carcinoma with cirrhosis

Figure 1 United Kingdom guidelines. Algorithm for surveillance of varices and primary prophylaxis in cirrhosis. ¹If there is clear evidence of disease progression this interval can be modified by clinician. Endoscopy should also be offered at time of decompensation[51].

Figure 2 Algorithm for treatment in Japanese hepatocellular carcinoma guidelines[67]. This algorithm has been simple and easy to memorize, consisting of three factors: (1) degree of liver damage; (2) number of tumors; and (3) tumor diameter. The recommendable treatment options are narrowed down to one or two by referring to this algorithm. HCC: Hepatocellular carcinoma.

Figure 3 Makuuchi’s criteria. Algorithm before proceeding to safety hepatectomy for hepatocellular carcinoma with cirrhotic liver. Makuuchi's criteria include three factors: ascites, total serum bilirubin, and the ICG-R₁₅: indocyanine green 15 min retention rate. This algorithm shows the maximal area for which an operation can be performed safely (modified ref.[11]).