Abstract
Objective and BackgroundThe aim of the present study was to develop and validate a prediction score for postoperative complications by severity and guide perioperative management and patient selection in hepatitis B-related hepatocellular carcinoma patients undergoing liver resection.MethodsA total of 1543 consecutive liver resections cases were included in the study. Randomly selected sample set of 70% of the study cohort was used to develop a score to predict complications III–V and the remaining 30% was used to validate the score. Based on the preoperative and predictable intraoperative parameters, logistic regression analysis was used to identify risk factors and create an integer score for the predicting of complication.ResultsAmerican Society of Anesthesiologists category, portal hypertension, major liver resection (more than 3 segments) and extrahepatic procedures were identified as independent predictors for complications III–V by logistic regression analysis. A score system integrating these 4 factors was stratified into three groups and significantly predicted the risk of complications III–V, with a rate of 1.6%, 11.9% and 65.6% for low, moderate and high risk, respectively. Using the score, the complications risk could be predicted accurately in the validation set, without significant differences between predicted (10.4%) and observed (8.4%) risks for complications III–V (P = 0.466).ConclusionsBased on four preoperative risk factors, we have developed and validated an integer-based risk score to predict postoperative severe complications after liver resection for hepatitis B-related hepatocellular carcinoma patients in high-volume surgical center. This score may contribute to preoperative risk stratification and clinical decision-making.
Highlights
With the refinement of surgical techniques and perioperative management in liver surgery in the last decades,postoperative morbidity and mortality has markedly decreased
According to several studies with large sample, the reported mortality after liver resection is less than 4% [1,2,3,4], the risk of postoperative complication remains high, with the incidence ranging from 20% to 50% [1,3,5]
The selection criteria for hepatecotmy was as follows: (1) Only patients with the Child-Turcotte-Pugh (CTP) score A were considered for hepatectomy in our center to prevent from poor outcomes, (2) The estimated remnant liver volume was more than 50% of the total functional liver volume, (3) hepatocellular carcinoma (HCC) patients without metastasis
Summary
With the refinement of surgical techniques and perioperative management in liver surgery in the last decades,postoperative morbidity and mortality has markedly decreased. According to several studies with large sample, the reported mortality after liver resection is less than 4% [1,2,3,4], the risk of postoperative complication remains high, with the incidence ranging from 20% to 50% [1,3,5]. The focus of liver surgery has turned on strategies to prevent nonlethal complications and develop tools to identify preoperatively potential patients at higher risk for severe complications [1]. To prevent complications,it is essential to identify, ideally preoperatively, those patients at risk to develop poor outcome and perform prevention strategies [14]. A simple and readily available prediction score to comprehensively identify patients undergoing liver resection at risk for postoperative severe complications is necessary and urgent. To enable meaningful protective interventions initiated before surgery or plan the operation, only predictive model including preoperative and predictable intraoperative parameters would perform better [1]
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