The Albumin-Indocyanine Green Evaluation (ALICE) Grade provides information about residual hepatic function prior to surgery. This can be used to determine the extent of surgery that can safely be performed. The authors are from multiple institutions in Japan, Switzerland, and England.
Patient selection: hepatocellular carcinoma
Parameters:
(1) ascites
(2) serum total bilirubin concentration (probably > 3 mg/dL)
(3) ALICE grade
If the patient has ascites or high serum total bilirubin, then surgery is contraindicated. These findings are associated with high Child-Pugh grades.
ALICE Grade
Liver Function
Surgery
Grade 1
normal
up to 6 segments
Grade 2a
impaired
up to 4 segments
Grade 2b
impaired
up to 3 segments
Grade 3
poor
limited resection, ablation, transplantation
Serum albumin is a strong predictor of liver function.
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