Postoperative Liver Failure Criteria for Predicting Mortality after Major Hepatectomy with Extrahepatic Bile Duct Resection

Abstract

Background: Post-hepatectomy liver failure (PHLF) is a serious complication after major hepatectomy with extrahepatic bile duct resection (Hx with EBDR) that may cause severe morbidity and even death. The purpose of this study was to compare several criteria systems as predictors of PHLF-related mortality following Hx with EBDR for perihilar cholangiocarcinoma (PHCC). Methods: The study cohort consisted of 222 patients who underwent Hx with EBDR for PHCC. We compared several criteria systems, including previously established criteria (the International Study Group of Liver Surgery (ISGLS) criterion; and the “50-50” criterion), and our institution’s novel systems “Max T-Bili” defined as total bilirubin (T-Bili) >7.3 mg/dL during post-operative days (POD) 1–7, and the “3-4-50” criterion, defined as total bilirubin >4 mg/dL and prothrombin time <50% on POD #3. Results: Thirteen patients (5.8%) died from PHLF-related causes. The 3-4-50 criterion showed high positive predictive values (39.1%), the 3-4-50, Max T-Bili, and 50-50 criterion showed high accuracies (91.7, 86.9, and 90.5%, respectively) and varying sensitivities (69.2, 69.2, and 38.5% respectively). Conclusions: The 3-4-50, Max T-Bili, and 50-50 criterion were all useful for predicting PHLF-related mortality after Hx with EBDR for PHCC.

Portal Vein Embolization is Associated with Reduced Liver Failure and Mortality in High-Risk Resections for Perihilar Cholangiocarcinoma

“…This is in contrast with the frequent use of PVE in Eastern series; 23 Eastern centers often report the use of PVE in the majority of patients. [23][24][25] The largest single-center series reported use of PVE in 60% of patients and while the rates of liver failure were comparable (32%), mortality was substantially lower at only 2%. 25 This remarkable difference in mortality has been noted across literature 23,26 and could well be due to the higher rates of PVE used in Eastern centers.…”

“…The matched cohorts were equal in all preoperative and operative variables, including the baseline FLRV share, which increased a median of 7 percentage points after PVE. The increase in true remnant liver volume after PVE was 42% (18-59) in a median of 22 (19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29) days. The use of PVE was associated with reductions in liver failure (from 36% to 8%; 4.4-fold reduction) and biliary leakage (from 35 to 10%; 3.5-fold reduction), and a decrease in 90-day mortality (from 18 to 7%; 2.6-fold reduction).…”

Validation study of postoperative liver failure and mortality risk scores after liver resection for perihilar cholangiocarcinoma

“…Validation study of postoperative liver failure and mortality risk scores after liver resection for perihilar cholangiocarcinoma thus exceeding those of other hepato-biliary procedures (2). Previous reports have shown that post-hepatectomy liver failure (PHLF) is a common and serious complication, with a reported incidence of 22% to 33% and high mortality rates of 52% to 68% (3)(4)(5)(6). Patients with PHCC usually have obstructive cholestasis and ultimately, jaundice due to the location of the tumour at the liver hilum (7)(8)(9).…”

“…Patients with PHCC usually have obstructive cholestasis and ultimately, jaundice due to the location of the tumour at the liver hilum (7)(8)(9). Cholestasis impairs the regenerative capacity of the liver after resection, which increases surgical risk, especially when the future liver remnant (FLR) volume (FLRV) is small (6,10,11). Therefore, it is essential to select candidates for PHCC surgery based not only on the tumour status but also on the patients' preoperative condition.…”

The comparative analysis of the effectiveness of stimulation of liver regeneration by bone marrow cells and total RNA of these cells

“…Обширную резекцию печени (ОРП) выполняют чаще всего при онкологических заболеваниях печени [1,2], а также у доноров при родственной трансплантации правой доли печени, масса которой составляет 70% и более [3]. Ее относят к критической травме, так как при этом удаляют от 60% и более общей массы печени и в пострезекционном периоде часто возникают клинические проявления острой печеночной недостаточности (ОПН), которые уже к концу первых суток наблюдаются у 13,0-25,8% пациентов, а показатель смертности от ОПН у этой категории больных в раннем послеоперационном периоде достигает 7% [4].…”