Preoperative Nomogram to Predict Post-Hepatectomy Liver Failure in Patients Undergoing Liver Resection

Abstract

Background: Post-hepatectomy liver failure (PHLF) is a rare but serious complication after liver resection (LR) and a leading cause of mortality. The aim of the present study was to define preoperative predictors of PHLF and propose a predictive nomogram to be utilized in preoperative planning. Methods: Consecutive patients planned for LR from October 2014 to August 2016 were prospectively recruited. Clinical and laboratory data including liver stiffness and indocyanine green retention at 15 min (ICG-R15) were collected at inclusion and until three months after LR. PHLF was defined by 50-50 criteria and/or postoperative peak total bilirubin >7mg/dL. Results: Four hundred and eighteen LRs were performed in 244 men and 174 women whose median age was 62 years. PHLF was observed in 19 patients (4.6%) after major LR in 17 and minor LR in two. Mortality rate in patients developing PHLF was 21.1% while mortality rate in the entire cohort of 418 patients was 2.2%. Independent predictors of PHLF were diabetes mellitus (odds ratio (OR): 6.6; 95% confidence interval (CI):1.1-39.3), pre-operative chemotherapy cycles ≥8 (OR: 4.1; CI:0.8-20.9), tumor size ≥51mm (OR: 4.8; CI:0.9-26.1), platelet count < 150,000/mL (OR: 8.7; CI:1.3-56.8), ICG-R15 (OR: 10.4; CI:1.9-58.1) and number of resected liver segments ≥3 (OR: 12.9; CI:1.3-125.4). Nomogram built with these six factors had area under receiver operating characteristic curve of 0.92 and goodness-of-fit of p=0.44. Conclusion: Predictive nomogram incorporating ICG-R15 would improve the safety of LR by enabling surgeons to identify high-risk patients and adapt the surgical strategy in them.