Ann Hepatobiliary Pancreat Surg.  2018 Aug;22(3):185-196. 10.14701/ahbps.2018.22.3.185.

Predictors of post-hepatectomy liver failure in patients undergoing extensive liver resections for hepatocellular carcinoma

• Chin KM
• Allen JC
• Teo JY
• Kam JH
• Tan EK
• Koh Y
• Goh BK
• Cheow PC
• Raj P
• Chow KH
• Chung YF
• Ooi LL
• Chan CY
• Lee SY

• KMID: 2420607
• DOI: http://doi.org/10.14701/ahbps.2018.22.3.185

Abstract

BACKGROUNDS/AIMS
To determine the prevalence of post-hepatectomy liver failure/insufficiency (PHLF/I) in patients undergoing extensive hepatic resections for hepatocellular carcinoma (HCC) and to assess the predictive value of preoperative factors for post-hepatectomy liver failure or insufficiency (PHLF/I).
METHODS
A retrospective review of patients who underwent liver resections for HCC between 2001 and 2013 was conducted. Preoperative parameters were assessed and analyzed for their predictive value of PHLF/I. Definitions used included the 50-50, International Study Group of Liver Surgery (ISGLS) and Memorial Sloan Kettering Cancer Centre (MSKCC) criteria.
RESULTS
Among the 848 patients who underwent liver resections for HCC between 2001 and 2013, 157 underwent right hepatectomy (RH) and extended right hepatectomy (ERH). The prevalence of PHLF/I was 7%, 41% and 28% based on the 50-50, ISGLS and MSKCC criteria, respectively. There were no significant differences in PHLF/I between RH and ERH. Model for End-Stage Liver Disease (MELD) score and bilirubin were the strongest independent predictors of PHLF/I based on the 50-50 and ISGLS/MSKCC criteria, respectively. Predictive models were developed for each of the criteria with multiple logistic regression.
CONCLUSIONS
MELD score, bilirubin, alpha-fetoprotein and platelet count showed significant predictive value for PHLF/I (all p < 0.05). A composite score based on these factors serves as guideline for physicians to better select patients undergoing extensive resections to minimize PHLF.

Keyword

Liver; Resection; Cirrhosis; Liver failure; Predictors

MeSH Terms

alpha-Fetoproteins
Bilirubin
Carcinoma, Hepatocellular*
Fibrosis
Hepatectomy
Humans
Liver Diseases
Liver Failure*
Liver*
Logistic Models
Platelet Count
Prevalence
Retrospective Studies
Bilirubin
alpha-Fetoproteins

Figure

• 

  Fig. 1 Receiver operating characteristic curve for predictive model under 50–50 criteria.

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