Post-hepatectomy liver failure in cirrhotic patients undergoing extensive liver resections – An Asian experience

Abstract

Aim: To determine the prevalence of post-hepatectomy liver failure/insufficiency (PHLF/I) in 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). Methods: A retrospective review of patients who underwent liver resections for HCC between 2001-2013 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. Results: 848 patients underwent liver resections for HCC between 2001-2013, of which 157 underwent right hepatectomy (RH) and extended right hepatectomy (ERH). The prevalence of PHLF/I was 7%, 41% and 28% for 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 for PHLF/I based on the 50-50 and ISGLS/MSKCC criteria, respectively. Predictive models were developed for each criteria with multiple logistic regression. Conclusion: MELD score, bilirubin, alpha-fetoprotein and platelet count had significant predictive value for PHLF/I (all p< 0.05). A composite score based on these factors can guide physicians to better select patients undergoing extensive resections to minimize PHLF.