Early Prediction of Post-hepatectomy Liver Failure in Patients Undergoing Major Hepatectomy Using a PHLF Prognostic Nomo
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ORIGINAL SCIENTIFIC REPORT
Early Prediction of Post-hepatectomy Liver Failure in Patients Undergoing Major Hepatectomy Using a PHLF Prognostic Nomogram Ken Min Chin1 • Ye Xin Koh1,2 • Nicholas Syn1 • Jin Yao Teo1,2 • Brian K. P. Goh1,2 Peng Chung Cheow1,2 • Yaw Fui Alexander Chung1,2 • London Lucien Ooi1,2 • Chung Yip Chan1,2 • Ser Yee Lee1,2
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Accepted: 17 July 2020 Ó Socie´te´ Internationale de Chirurgie 2020
Abstract Background Liver resection (LR) is the main modality of treatment for hepatocellular carcinoma (HCC) and colorectal liver metastasis (CRLM). Post-hepatectomy liver failure (PHLF) remains the most dreaded complication. We aim to create a prognostic score for early risk stratification of patients undergoing LR. Methodology Clinical and operative data of 472 patients between 2000 and 2016 with HCC or CRLM undergoing major hepatectomy were extracted and analysed from a prospectively maintained database. PHLF was defined using the 50–50 criteria. Results Liver cirrhosis and fatty liver were histologically confirmed in 35.6% and 53% of patients. 4.7% (n = 22) of patients had PHLF. A 90-day mortality was 5.1% (n = 24). Pre-operative albumin–bilirubin score (p = 0.0385), prothrombin time (p \ 0.0001) and the natural logarithm of the ratio of post-operative day 1 to pre-operative serum bilirubin (SB) (ln(POD1Bil/pre-opBil); p \ 0.0001) were significantly independent predictors of PHLF. The PHLF prognostic nomogram was developed using these factors with receiver operating curve showing area under curve of 0.88. Excellent sensitivity (94.7%) and specificity (95.7%) for the prediction of PHLF (50–50 criteria) were achieved at cut-offs of 9 and 11 points on this model. This score was also predictive of PHLF according to PeakBil [ 7 and International Study Group for Liver Surgery criteria, intensive care unit admissions, length of stay, all complications, major complications, re-admissions and mortality (p \ 0.05). Conclusions The PHLF nomogram (https://tinyurl.com/SGH-PHLF-Risk-Calculator) can serve as a useful tool for early identification of patients at high risk of PHLF before the ‘point of no return’. This allows enforcement of closer monitoring, timely intervention and mitigation of adverse outcomes.
Abbreviations PPV Positive predictive value NPV Negative predictive value
NE
& Ye Xin Koh [email protected]
Introduction
1
Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, 20 College Road, Singapore 169856, Singapore
2
Duke-National University of Singapore (NUS) Medical School Singapore, 8 College Road, Singapore 169857, Singapore
Not evaluable
Hepatocellular carcinoma (HCC) and colorectal liver metastasis (CRLM) are the most common causes of primary and secondary liver tumours [1, 2]. Although the curative options that offer greatest survival benefit are liver resection (LR) and transplantation (LT), shortage of donor
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World J Surg
organs limits the applicability of LT [3, 4]. LR thus remains the mainstay of treatment. LR has been refined
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