The preoperative assessment of portal pressure is important for selecting a treatment modality and ensuring safe liver surgery for hepatic malignancy. A hepatic venous pressure gradient (HVPG) of 10 mmHg is regarded as cutoff value for surgical decisions for safe hepatic surgery. However, this method may have procedure-related complications, and it is rarely performed in the East. This study was conducted with two aims: to determine calculated HVPG (cHVPG) using serologic test values and to evaluate the clinical reliability of cHVPG for surgical patients with limited liver function. For this purpose, 171 patients who had undergone hepatic surgery in a tertiary hospital between 2006 and 2008 were enrolled. For all 171, we performed simultaneous preoperative measurement of HVPG, a dye-retention test (Indocyanine green 15-minute retention test (ICG-R15)), complete blood cell counts, and routine chemistry. HVPG values were correlated with ICG-R15, platelet count, serum albumin, and prothrombin time (PT-INR) by multivariate analysis (P < 0.05). Using linear regression analysis, cHVPG was calculated by the following equation: cHVPG (mmHg) = 0.209 × ICG-R15 (%) ? 1.646 × Albumin (g/dL) ? 0.01 × Platelet counts (103) + 1.669 × PT-INR + 8.911 (Adj.R2=0.707). Between 2008 and 2013, 510 patients with hepatocellular carcinoma were evaluated for surgery. Among them, 68 patients with ICG-R15 > 20% presented cHVPG values lower than 10mmHg. They received curative hepatectomy and recovered without major morbidity such as posthepatectomy liver failure. In conclusion, HVPG can be calculated by the equation using ICG-R15, platelet count, serum albumin, PT-INR, and serum total bilirubin. cHVPG could be a reliable alternative to HVPG for selecting the modality of liver surgery.
