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

Abstract

Background: Surgery for perihilar cholangiocarcinoma (PHCC) remains a challenging procedure with high morbidity and mortality. The Academic Medical Center (Amsterdam UMC) and Memorial Sloan Kettering Cancer Center proposed a postoperative mortality risk score (POMRS) and post-hepatectomy liver failure score (PHLFS) to predict patient outcomes. This study aimed to validate the POMRS and PHLFS for PHCC patients at Hokkaido University. Methods: Medical records of 260 consecutive PHCC patients who had undergone major hepatectomy with extrahepatic bile duct resection without pancreaticoduodenectomy at Hokkaido University between March 2001 and November 2018 were evaluated to validate the PHLFS and POMRS. Results:The observed risks for PHLF were 13.7%, 24.5%, and 39.8% for the low-risk, intermediaterisk, and high-risk groups, respectively, in the study cohort. A receiver-operator characteristic (ROC) analysis revealed that the PHLFS had moderate predictive value, with an analysis under the curve (AUC) value of 0.62.Mortality rates based on the POMRS were 1.7%, 5%, and 5.1% for the low-risk, intermediate-risk, and high-risk groups, respectively. The ROC analysis demonstrated an AUC value of 0.58.Conclusions: This external validation study showed that for PHLFS the threshold for discrimination in an Eastern cohort was reached (AUC >0.6), but it would require optimization of the model before use in clinical practice is acceptable. The POMRS were not applicable in the eastern cohort. Further external validation is recommended.

The efficiency of postoperative liver failure and mortality risk scores after liver resection for perihilar cholangiocarcinoma

“…(1). Furthermore, after a careful review, we noticed that the authors appeared to have made some apparent mistake inadvertently in Tables 4 and 5 (1,3). Preoperative cholangitis should fulfill all 3 criteria including higher than 38 ℃, after new placement of a drainage catheter the temperature decreased, and/or liver abscess formation with fever in Noji et al study (1).…”

“…2 in Ref. ( 1 ). Furthermore, after a careful review, we noticed that the authors appeared to have made some apparent mistake inadvertently in Tabs.…”

“…To begin with, basing on PHLF risk score of AMC/MSKCC (2), the predicted risk of PHLF of high risk with total points of 7 is 77% not 67% in Table 2 in Ref. (1). Furthermore, after a careful review, we noticed that the authors appeared to have made some apparent mistake inadvertently in Tables 4 and 5 (1,3).…”

“…First, there are some obvious mistakes in Tables 2, 4 and 5 in Ref. (1). Table 2 was listed to show the risks predicted by the post-hepatectomy liver failure (PHLF) risk score of Hokkaido University and AMC/MSKCC.…”

“…With great interest, we read the literature by Noji et al . entitled “ Validation study of postoperative liver failure and mortality risk scores after liver resection for perihilar cholangiocarcinoma ” ( 1 ), which was published in the latest issue of Hepatobiliary Surgery Nutrition . The authors have reached an important conclusion that postoperative mortality risk score (POMRS) and post-hepatectomy liver failure score (PHLFS) proposed by the Academic Medical Center (AMC) and Memorial Sloan Kettering Cancer Center (MSKCC) require optimization before use in clinical practice.…”