Predictors of post-hepatectomy liver failure in patients undergoing extensive liver resections for hepatocellular carcinoma

• Published in: Annals of hepato-biliary-pancreatic surgery 2018-08, Vol.22 (3), p.185-196
• Main Authors: Chin, Ken Min, Allen, John Carson, Teo, Jin Yao, Kam, Juinn Huar, Tan, Ek Khoon, Koh, Yexin, Goh, Kim Poh Brian, Cheow, Peng Chung, Raj, Prema, Chow, Kah Hoe Pierce, Chung, Yaw Fui Alexander, Ooi, London Lucien, Chan, Chung Yip, Lee, Ser Yee
• Format: Article
• Language: English
• Subjects: Original
• ISSN: 2508-5778; 2508-5859
• DOI: 10.14701/ahbps.2018.22.3.185

To determine the prevalence of post-hepatectomy liver failure/insufficiency (PHLF/I) in patients undergoing extensive hepatic resections for hepatocellular carcinoma (HCC) and to assess the predictive value of preoperative factors for post-hepatectomy liver failure or insufficiency (PHLF/I). A retrospective review of patients who underwent liver resections for HCC between 2001 and 2013 was conducted. Preoperative parameters were assessed and analyzed for their predictive value of PHLF/I. Definitions used included the 50-50, International Study Group of Liver Surgery (ISGLS) and Memorial Sloan Kettering Cancer Centre (MSKCC) criteria. Among the 848 patients who underwent liver resections for HCC between 2001 and 2013, 157 underwent right hepatectomy (RH) and extended right hepatectomy (ERH). The prevalence of PHLF/I was 7%, 41% and 28% based on the 50-50, ISGLS and MSKCC criteria, respectively. There were no significant differences in PHLF/I between RH and ERH. Model for End-Stage Liver Disease (MELD) score and bilirubin were the strongest independent predictors of PHLF/I based on the 50-50 and ISGLS/MSKCC criteria, respectively. Predictive models were developed for each of the criteria with multiple logistic regression. MELD score, bilirubin, alpha-fetoprotein and platelet count showed significant predictive value for PHLF/I (all