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

2020 ◽  
pp. 1-8
Author(s):  
Geraldine Yanlei Lei ◽  
Liang Shen ◽  
Sameer P. Junnarkar ◽  
CheongWei Terence Huey ◽  
JeeKeem Low ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Blood Loss ◽  
Hepatic Resection ◽  
Serum Bilirubin ◽  
Performance Indicator ◽  
Peak Serum ◽  
Intraoperative Blood Loss ◽  
Perioperative Outcome ◽  
Short Term ◽  
Cox's Regression

<b><i>Background/Purpose:</i></b> 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. <b><i>Methods:</i></b> 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. <b><i>Results:</i></b> 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 (<i>p</i> &#x3c; 0.001), intraoperative blood loss (<i>p</i> = 0.013), the 50-50 criteria for PHLF (<i>p</i> &#x3c; 0.001) on postoperative day 5, and peak serum bilirubin &#x3e;119 µmol/L (<i>p</i> = 0.007) on postoperative day 3 predict 90-day mortality. <b><i>Conclusion:</i></b> 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 &#x3e;119 µmol/L on postoperative day 3 predict 90-day mortality following elective HR for HCC.

Outcomes of Pure Laparoscopic versus Open Hepatic Resection for Hepatocellular Carcinoma in Cirrhotic Patients: A Case-Control Study with Propensity Score Matching

2015 ◽  
Vol 55 (4) ◽  
pp. 291-301 ◽  
Author(s):  
Shogo Tanaka ◽  
Shigekazu Takemura ◽  
Hiroji Shinkawa ◽  
Takayoshi Nishioka ◽  
Genya Hamano ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Propensity Score ◽  
Blood Loss ◽  
Hepatic Resection ◽  
Propensity Score Matching ◽  
Activity Index ◽  
Disease Free Survival ◽  
Intraoperative Blood Loss ◽  
Laparoscopic Hepatic Resection ◽  
Cirrhotic Patients

Background/Purpose: Laparoscopic hepatic resection (LH) for hepatocellular carcinoma (HCC) has gradually gained ground as a safe and minimally invasive treatment, although LH for cirrhotic patients remains challenging. Methods: Between January 2007 and August 2014, 28 and 57 patients with histologically proven cirrhosis (histological activity index, fibrosis score 4) underwent pure LH and open hepatic resection (OH; less than segmentectomy), respectively, for peripheral HCC ≤5 cm. To correct the difference in clinicopathological factors, including difficulty scores, between the two groups, propensity score matching was used at a 1:1 ratio, which resulted in a comparison of 20 patients per group. We compared the short- and long-term outcomes of LH and OH to investigate the efficacy of LH. Results: Clinicopathological variables, including difficulty scores, were well balanced between the two groups. The incidence of complications and mean intraoperative blood loss were lower in the LH group than the OH group (0 vs. 45% and 180 vs. 440 ml, p = 0.001 and 0.04, respectively). The 3-year disease-free survival rate was 42% in the LH group and 30% in the OH group (p = 0.533), whereas the 5-year overall survival rates were 46 and 60%, respectively (p = 0.606). Conclusions: LH is a safe and effective treatment option for cirrhotic patients with HCC in terms of intraoperative blood loss and morbidity.

scholarly journals A non-bioartificial liver support system combined with transplantation in HBV-related acute-on-chronic liver failure

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Peng Li ◽  
Xi Liang ◽  
Shan Xu ◽  
Ye Xiong ◽  
Jianrong Huang
Keyword(s):  
Survival Rate ◽  
Blood Loss ◽  
Liver Failure ◽  
Control Group ◽  
Observation Group ◽  
Intraoperative Blood Loss ◽  
Chronic Liver Failure ◽  
Short Term ◽  
Liver Support ◽  
Liver Support System

AbstractWe aim to determine the impact of an artificial liver support system (ALSS) treatment before liver transplantation (LT), and identify the prognostic factors and evaluate the predictive values of the current commonly used ACLF prognostic models for short-term prognosis after LT. Data from 166 patients who underwent LT with acute-on-chronic liver failure (ACLF) were retrospectively collected from January 2011 to December 2018 from the First Affiliated Hospital of Zhejiang University School of Medicine. Patients were divided into two groups depending on whether they received ALSS treatment pre-LT. In the observation group, liver function tests and prognostic scores were significantly lower after ALSS treatment, and the waiting time for a donor liver was significantly longer than that of the control group. Both intraoperative blood loss and period of postoperative ICU care were significantly lower; however, there were no significant differences between groups in terms of total postoperative hospital stays. Postoperative 4-week and 12-week survival rates in the observation group were significantly higher than those of the control group. Similar trends were also observed at 48 and 96 weeks, however, without significant difference. Multivariate Cox regression analysis of the risk factors related to prognosis showed that preoperative ALSS treatment, neutrophil–lymphocyte ratio, and intraoperative blood loss were independent predicting factors for 4-week survival rate after transplantation. ALSS treatment combined with LT in patients with HBV-related ACLF improved short-term survival. ALSS treatment pre-LT is an independent protective factor affecting the 4-week survival rate after LT.

scholarly journals A proposed model on MR elastography for predicting postoperative major complications in patients with hepatocellular carcinoma

BJR|Open ◽  
2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Kazu Shibutani ◽  
Masahiro Okada ◽  
Jitsuro Tsukada ◽  
Tomoko Hyodo ◽  
Kenji Ibukuro ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Blood Loss ◽  
Prediction Model ◽  
Cross Validation ◽  
Mr Elastography ◽  
Intraoperative Blood Loss ◽  
Discriminative Performance ◽  
Liver Remnant ◽  
Major Complications ◽  
Lemeshow Test

Objective: To develop a model for predicting post-operative major complications in patients with hepatocellular carcinoma (HCC). Methods: In all, 186 consecutive patients with pre-operative MR elastography were included. Complications were categorised using Clavien‒Dindo classification, with major complications defined as ≥Grade 3. Liver-stiffness measurement (LSM) values were measured on elastogram. The indocyanine green clearance rate of liver remnant (ICG-Krem) was based on the results of CT volumetry, intraoperative data, and ICG-K value. For an easy application to the prediction model, the continuous variables were converted to categories. Moreover, logistic regression analysis and fivefold cross-validation were performed. The prediction model’s discriminative performance was evaluated using the area under the receiver operating characteristic curve (AUC), and the calibration of the model was assessed by the Hosmer‒Lemeshow test. Results: 43 of 186 patients (23.1%) had major complications. The multivariate analysis demonstrated that LSM, albumin–bilirubin (ALBI) score, intraoperative blood loss, and ICG-Krem were significantly associated with major complications. The median AUC of the five validation subsets was 0.878. The Hosmer-Lemeshow test confirmed no evidence of inadequate fit (p = 0.13, 0.19, 0.59, 0.59, and 0.73) on the fivefold cross-validation. The prediction model for major complications was as follows: −2.876 + 2.912 [LSM (>5.3 kPa)]+1.538 [ALBI score (>−2.28)]+0.531 [Intraoperative blood loss (>860 ml)]+0.257 [ICG-Krem (<0.10)]. Conclusion: The proposed prediction model can be used to predict post-operative major complications in patients with HCC. Advances in knowledge: The proposed prediction model can be used in routine clinical practice to identify post-operative major complications in patients with HCC and to strategise appropriate treatments of HCC.

Potential role of cholinesterases to predict short-term outcome after hepatic resection for hepatocellular carcinoma

2012 ◽  
Vol 65 (1) ◽  
pp. 11-18 ◽  
Author(s):  
Matteo Donadon ◽  
Matteo Cimino ◽  
Fabio Procopio ◽  
Emanuela Morenghi ◽  
Marco Montorsi ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Hepatic Resection ◽  
Potential Role ◽  
Short Term ◽  
Term Outcome ◽  
Short Term Outcome

Impact of intraoperative blood loss on the short-term outcomes of laparoscopic liver resection

2017 ◽  
Vol 31 (11) ◽  
pp. 4451-4457 ◽  
Author(s):  
Rahul Gupta ◽  
David Fuks ◽  
Christophe Bourdeaux ◽  
Pejman Radkani ◽  
Takeo Nomi ◽  
...  
Keyword(s):  
Liver Resection ◽  
Blood Loss ◽  
Laparoscopic Liver Resection ◽  
Intraoperative Blood Loss ◽  
Short Term
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