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

Ken Min Chin; John Carson Allen; Jin Yao Teo; Juinn Huar Kam; Ek Khoon Tan; Yexin Koh; Kim Poh Brian Goh; Peng Chung Cheow; Prema Raj; Kah Hoe Pierce Chow; Yaw Fui Alexander Chung; London Lucien Ooi; Chung Yip Chan; Ser Yee Lee

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저자정보: Ken Min Chin (Singapore General Hospital) John Carson Allen (Duke-National University) Jin Yao Teo (Singapore General Hospital) Juinn Huar Kam (Singapore General Hospital) Ek Khoon Tan (Singapore General Hospital) Yexin Koh (Singapore General Hospital) Kim Poh Brian Goh (Singapore General Hospital) Peng Chung Cheow (Singapore General Hospital) Prema Raj (Singapore General Hospital) Kah Hoe Pierce Chow (Singapore General Hospital) Yaw Fui Alexander Chung (Singapore General Hospital) London Lucien Ooi (Singapore General Hospital) Chung Yip Chan (Singapore General Hospital) Ser Yee Lee (Singapore General Hospital)

저널정보: 한국간담췌외과학회 Annals of Hepato-Biliary-Pancreatic Surgery 한국간담췌외과학회지 제22권 제3호

발행연도: 2018.8

수록면: 185 - 196 (12page)

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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.

#Liver #Resection #Cirrhosis #Liver failure #Predictors

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