A cohort study of hepatectomy-related complications and prediction model for postoperative liver failure after major liver resection in 1,441 patients without obstructive jaundice

Abstract

Background: This cohort study, based on a large sample of extensive hepatectomy cases, aimed to analyze the distribution of hepatectomy-related complications and to develop a predictive model of posthepatectomy liver failure (PHLF).Methods: Data of patients who underwent hepatectomy of ≥3 liver segments at the Eastern Hepatobiliary Surgery Hospital from 2000 to 2016 were collected and analyzed. Information on hepatectomy-related complications was collected and risk factors were analyzed. A total of 1,441 eligible patients were randomly assigned at 3:1 ratio into the derivation (n=1,080) and validation (n=361) cohorts. The multivariable logistic regression model was used to establish the prediction model of PHLF in the derivation cohort.Results: The incidence rates of PHLF, ascites, bile leakage, intra-abdominal bleeding, and abscesses were 58.22%, 10.76%, 11.17%, 9.71%, and 4.16%, respectively. The 90-day perioperative mortality rate was 1.32%. Multivariate analyses found that age, gender, platelet, creatinine, gamma-glutamyltransferase, thrombin time, fibrinogen, hepatitis B e (HBe) antigen positive, and number of resected liver segments were independent prognostic factors of PHLF in the derivation cohort and included in the nomogram. The prediction model demonstrated good discrimination [area under the curve =0.726, 95% confidence interval (CI), 0.696-0.760, P<0.0001] and calibration.Conclusions: Our study showed a high perioperative safety and a low risk of serious complications in patients who underwent major liver resection (MLR) at a large hepatobiliary surgery center. Routine preoperative clinical information can be used to develop a postoperative liver failure risk prediction model for rational planning of surgery.

A Novel Nomogram for Predicting Postoperative Liver Failure After Major Hepatectomy for Hepatocellular Carcinoma

“…As no tool exists to predict PHLF after major hepatectomy for HCC, this predictive model might serve as a quantitative scoring system to individually estimate the risk of PHLF and to select HCC patients for major hepatectomy. PHLF was one of the most common complications and the leading cause of mortality after PH, particularly in patients who underwent major hepatectomy (3)(4)(5)(6)(7)24). In the present study, 155 (22.5%) and 37 (19.3%) patients in the training and validation cohorts met the ISGLS criteria for PHLF, respectively.…”

“…Although postoperative morbidity and mortality have decreased over the past decades with advances in surgical techniques and perioperative management (1,2), they remain high in HCC patients who underwent major hepatectomy. Previous studies have revealed that post-hepatectomy liver failure (PHLF) is one of the most seriously complications and the main cause of mortality particularly in patients undergoing major hepatectomy (3)(4)(5)(6)(7). Therefore, accurate preoperative prediction of the risk of PHLF is essentially important for patient selection and perioperative management.…”

External Validation of Six Liver Functional Reserve Models to predict Posthepatectomy Liver Failure after Major Resection for Hepatocellular Carcinoma

“…A multicentric retrospective analysis of patients with hepatocellular carcinoma who underwent major hepatectomy (≥ 3 segments) from the Eastern Hepatobiliary Surgery Hospital in Shanghai, Zhongda Hospital, Southeast university in Nanjing, Qin Huai Medical District of Eastern Theater General Hospital in Nanjing and The First Affiliated Hospital of Xi'an Jiao Tong University in Xi'an between January 01, 2008 and December 31, 2019 were recorded. Inclusion criteria are obeyed strictly as follows: (1) pathologically confirmed as hepatocellular carcinoma; (2) underwent major hepatectomy, major hepatectomy is defined as resection of Couinaud's segmentation 3 and above 4 ; (3) no anti-tumor treatment before surgery, such as ablation, TACE; (4) no major blood vessel invasion, bile duct cancer thrombus and distant metastasis; (5) age ≥18. Exclusion criteria: (1) intraoperative radiofrequency ablation, particle placement and other treatments; (2) data were missing on the fifth day after surgery, and PHLF could not be defined.…”

“…(2) underwent major hepatectomy, major hepatectomy is defined as resection of Couinaud's segmentation 3 and above [4]; (3) no anti-tumor treatment before surgery, such as ablation, TACE; (4) no major blood vessel invasion, bile duct cancer thrombus and distant metastasis; (5) age ≥18. Exclusion criteria: (1) intraoperative radiofrequency ablation, particle placement and other treatments; (2) data were missing on the fifth day after surgery, and PHLF could not be defined.…”

“…However, postoperative morbidity and mortality still exists, and posthepatectomy liver failure (PHLF) remains the most common cause of mortality particularly in patients who underwent major hepatectomy 2 . The reported incidence of PHLF is 0.7%-9.1%, especially in patients underwent major hepatectomy as high as 58.22%, and PHLF is shown as the major cause (between 18% and 75%) of postoperative mortality 3 - 4 . In consideration of such a high incidence, accurate prediction of PHLF is very important for patient selection and perioperative management in HCC patients following major hepatectomy.…”