Predicting morbidity of liver resection

Madhavan, Sudharsan; Shelat, Vishal G; Soong, Su-Lin; Woon, Winston; Huey, Terence; Chan, Yiong Huak; Junnarkar, Sameer P

doi:10.1007/s00423-018-1656-3

Cited by 26 publications

(25 citation statements)

References 46 publications

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“…It has been suggested that, in addition to tumor burden, the severity of liver function dysfunction influences treatment options and HCC peri-operative outcomes. 2,3 Worldwide, Child-Pugh (C-P) classification system is widely considered as an important tool to assess preoperative liver function. The C-P grade incorporates serum total bilirubin (TBIL), albumin (ALB), coagulation function, presence of ascites, and hepatic encephalopathy.…”

Section: Introductionmentioning

confidence: 99%

The Significance of Platelet–Albumin–Bilirubin (PALBI) Grade in Hepatocellular Carcinoma Patients Stratified According to Platelet Count

Pang¹,

Liu²,

Wang³

et al. 2020

CMAR

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Background Platelet–albumin–bilirubin (PALBI) has been demonstrated to be superior to conventional Child–Pugh (C-P) grade in evaluating liver function and prognosis of HCC patients. However, both thrombocytosis and thrombocytopenia are unfavorable for HCC survival. The aim of this study was to preliminarily investigate the prognostic value of PALBI in HCC patients with thrombocytopenia and excluding thrombocytopenia. Methods In this retrospective cohort study, we reviewed 465 cases of HCC patients who underwent radical surgery. PALBI grade was calculated based on preoperative serological examinations. The primary outcomes were overall survival (OS) and recurrence-free survival (RFS), which were assessed by Kaplan–Meier method and Cox regression. The prognostic performances of PALBI and other models were estimated by using the concordance index (C-index). Results During a median follow-up time of 28 months, 31.6% (147/465) of patients died and 33.5% (156/465) experienced recurrence. Multivariate analyses revealed that both thrombocytosis and thrombocytopenia were independently associated with poor OS and RFS compared with normal platelet count (PLT) in HCC patients. Stratified analysis further revealed that PALBI was a significant predictor for HCC survival in patients excluding thrombocytopenia but not in patients with thrombocytopenia. In particular, in HCC patients excluding thrombocytopenia, the combination of tumor size with PALBI (C-index = 0.730, 95% CI: 0.674–0.786) may be superior to the classical Barcelona Clinic Liver Cancer (BCLC) and Cancer of Liver Italian Program (CLIP) staging systems in predicting survival. Conclusion In conclusion, PALBI grade, in particular the combination with tumor size, is an effective model for discriminating survival in HCC patients excluding thrombocytopenia but not in thrombocytopenic HCC patients.

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Section: Introductionmentioning

confidence: 99%

The Significance of Platelet–Albumin–Bilirubin (PALBI) Grade in Hepatocellular Carcinoma Patients Stratified According to Platelet Count

Pang¹,

Liu²,

Wang³

et al. 2020

CMAR

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“…The patients were scored for ASA physical status classification and referred appropriately to the cardiology or respiratory unit for optimization of comorbidities. Selected patients were offered cardiopulmonary exercise testing, and we determined an anaerobic threshold of < 11 mL/kg/min as a contraindication to HR [12]. The standard operating principles of both open and laparoscopic liver surgery at our unit were published previously [13].…”

Section: Methodsmentioning

confidence: 99%

“…Furthermore, many authors validate their data with existing scoring systems, which were either not designed exclusively for HR in the first place or derived from different patient profiles [11][12][13]. Hence there is a paucity of data with regard to variables predicting 90-day mortality following elective HR for HCC.…”

Section: Introductionmentioning

confidence: 99%

Predictors of 90-Day Mortality following Hepatic Resection for Hepatocellular Carcinoma

et al. 2020

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Background/Purpose: 90-day mortality is a key performance indicator for short-term perioperative outcome of hepatic resection (HR). Although many preoperative, intraoperative, and postoperative variables predict 90-day mortality following elective HR, only few are specific to hepatocellular carcinoma (HCC). This study aims to determine the predictors of 90-day mortality following elective HR for HCC. Methods: We report a retrospective analysis of patients who underwent elective HR between January 1, 2007, and December 31, 2017. Health status, perioperative variables, and the presence of post-hepatectomy liver failure (PHLF) were studied. Cox’s regression evaluated factors predicting 90-day mortality. Results: Two hundred and forty-four patients diagnosed with HCC underwent HR; 102 (41.8%) underwent a major HR. The postoperative 90-day mortality rate was 5.3%. Multivariate analysis demonstrated that Child-Pugh score (p < 0.001), intraoperative blood loss (p = 0.013), the 50-50 criteria for PHLF (p < 0.001) on postoperative day 5, and peak serum bilirubin >119 µmol/L (p = 0.007) on postoperative day 3 predict 90-day mortality. Conclusion: In patients with HCC undergoing HR, Child-Pugh score, intraoperative blood loss, the 50-50 criteria for PHLF on postoperative day 5, and peak serum bilirubin >119 µmol/L on postoperative day 3 predict 90-day mortality following elective HR for HCC.

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“…Hepato-pancreatico-biliary surgery is complex and many units have adopted prehabilitation. In a local study [18] including 245 patients with liver resection the post-operative morbidity, 30-day mortality and 90-day mortality was 38.3%, 2.4% and 3.7% respectively. In a local study [19] including 196 patients with pancreatic resection, the rate of grade B and C post-operative pancreatic fistula, 30-day mortality and 90-day mortality was 5.1%, 0.5% and 2%, respectively.…”

Section: Prehabilitation In Hepato-pancreatico-biliary Surgerymentioning

confidence: 99%

“…One method of patient selection is by virtue of risk prediction. Various risk prediction models are reported in diverse pathologies and surgeries to enhance resource allocation [18,34,35] . A prospective study on 162 patients undergoing hepatopancreaticobiliary surgery by van der Windt et al [36] , showed that scoring systems such as the Risk Analysis Index, was able to accurately predict post-operative outcomes in patients.…”

Section: Target Populationmentioning

confidence: 99%

Prehabilitation in elderly patients scheduled for liver resection and protocol for Recovery Of Surgery in Elderly

Mohan¹,

Huey²,

Junnarkar³

et al. 2020

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Ageing population of first world economies pose unique challenges to surgical community. Enhanced recovery after surgery protocols and pathways do not attempt to optimize or enhance physical function of patients by customized program of physical activity. Increasingly, prehabilitation programs (PP) have gained momentum in orthopaedics, urology, colorectal surgery and hepatopancreaticobiliary surgery. Current evidence of PP in various elective surgical procedures have shown improved outcomes with minimal to none drawback or harm. There is emerging evidence of role of PP in elective liver resection. The aim of this paper is to review the basis of PP and share local multidisciplinary team protocol specifically customized to frail and elderly population-Recovery Of Surgery in Elderly.

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Predicting morbidity of liver resection

Abstract: In patients undergoing LR, the ACS-NSQIP surgical risk calculator was superior to POSSUM in predicting morbidity risk.

Cited by 26 publications

References 46 publications

<p>The Significance of Platelet–Albumin–Bilirubin (PALBI) Grade in Hepatocellular Carcinoma Patients Stratified According to Platelet Count</p>

<p>The Significance of Platelet–Albumin–Bilirubin (PALBI) Grade in Hepatocellular Carcinoma Patients Stratified According to Platelet Count</p>

Predictors of 90-Day Mortality following Hepatic Resection for Hepatocellular Carcinoma

Prehabilitation in elderly patients scheduled for liver resection and protocol for Recovery Of Surgery in Elderly

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