Reevaluation of Makuuchi’s criteria for resecting hepatocellular carcinoma: A Japanese nationwide survey

Aim Although Makuuchi’s criteria are widely used to determine the cut‐off for safe liver resection, there have been few reports of concrete data supporting their validity. Here, we verified the utility of Makuuchi’s criteria by comparing the operative mortality rates associated with liver resection between hepatocellular carcinoma (HCC) patients meeting or exceeding the criteria. Methods A database was built using data from 15 597 patients treated between 2000 and 2007 for whom values for all three variables included in Makuuchi’s criteria for liver resection (clinical ascites, serum bilirubin, and indocyanine green clearance) were available. The patients were divided into those fulfilling (n = 12 175) or exceeding (n = 3422) the criteria. The postoperative mortality (death for any reason within 30 days) and long‐term survival were compared between the two groups. Results The operative mortality rate was significantly lower in patients meeting the criteria than in those exceeding the criteria (1.07% vs. 2.01%, respectively; p