Prediction of Mortality Rate After Major Hepatectomy in Patients Without Cirrhosis

Abstract

This study shows that preoperative liver tests and function can predict postoperative fatal outcome in patients presenting with biliary carcinomas and requiring a major liver resection. On the basis of these preoperative biological parameters, a decision-making algorithm is provided.

Defining Post Hepatectomy Liver Insufficiency: Where do We stand?

“…The correlation between PHLF and conventional laboratory parameters representing different synthetic and excretory functions of the liver such as alanine aminotransferase (ALT), aspartate aminotransferase (ALT), alkaline phosphatase (ALP), gamma-glutamyl transpeptidase (GGT), bilirubin, lactate dehydrogenase (LDH), albumin and prothrombin time (PT) has been extensively reported in the literature. [65][66][67][68][69][70][71][72] None of these laboratory factors taken alone have been shown to provide an adequate evaluation of liver function; however, a combination of biochemical parameters has been included in different scoring systems to evaluate preoperative hepatic function.…”

“…The absorption and emission spectrum of ICG are both in the near infrared range allowing for measurements to be performed by non-invasive monitoring. 10,65,[84][85][86][87][88][89][90] The ICGR-R15 test has been shown to predict more accurately PHLF compared with both the ChildPugh classification 91 and MELD model. 92 There is no clear consensus on the cut-off value for ICG-R15 allowing for safe hepatic surgery.…”

Major hepatectomies for perihilar cholangiocarcinoma: Predictors for clinically relevant postoperative complications using the International Study Group of Liver Surgery definitions

“…1 Major hepatectomies with extrahepatic bile duct resection and loco-regional lymphadenectomy represent the standard approach for curative-intent surgery in the largest part of patients with PHC and have been associated with significant improvements for resectability and survival rates. 2e6 Nowadays, decreased mortality rates after major hepatectomies were observed in referral centers, 4e7 but for patients with PHC mortality rates are significantly higher compared with other pathologies 8 and ranges from 1.4% to 12%. 2e6,9,10 Major hepatectomies with zero mortality were also reported.…”

“…2e6,9,10 Major hepatectomies with zero mortality were also reported. 11 Conversely, morbidity rates after major hepatectomies are still high, 8,12 particularly in patients with PHC because they are more likely to present added potential risk factors such as obstructive jaundice with or without cholangitis. 10,12 Thus, morbidity rates after hepatectomies for PHC ranges from 43% to 81% 2e6, 9,10,13 and the main complications are represented by liver failure, hemorrhage, and septic complications due to bile leak.…”

“…10,12 Thus, morbidity rates after hepatectomies for PHC ranges from 43% to 81% 2e6, 9,10,13 and the main complications are represented by liver failure, hemorrhage, and septic complications due to bile leak. 2e6, 8,10,13 In the literature, there is a broad spectrum of definitions for major liver resections. 8,9,11,13e16 Recently, it was suggested that resection of four or more liver segments should be considered the standard definition for major hepatectomies.…”