Skip to main content

Advertisement

SpringerLink
Log in

The Predictive Value of Postoperative Clinical Risk Scores for Outcome After Hepatic Resection: A Validation Analysis in 807 Patients

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Although early postoperative risk stratification might allow a more precise prediction of outcomes after hepatic resection, evaluation of different postoperative clinical risk indices has been lacking.

Methods

A total of 1,219 patients underwent hepatic resection between January 2002 and 2010, and 807 patients were eligible for final analyses. The model for end stage liver disease (MELD) score, the “50–50 criteria,” and the International Study Group of Liver Surgery (ISGLS) definition of posthepatectomy liver failure (PHLF) were assessed as clinical risk scores on postoperative day 5. Risk factors for morbidity and mortality were analyzed using multivariate logistic regression analyses.

Results

The overall morbidity and mortality rates were 43 and 6%, respectively. Sensitivity of the MELD score, the 50–50 criteria and the PHLF for prediction of morbidity and mortality were 55, 6, 23 and 71, 26, 65%. On multivariate analyses MELD score [odds ratio (OR) 2.06; 95% confidence interval (95% CI) 1.41–3.02] and PHLF (5.61; 2.73–11.55) were associated with morbidity, whereas this association did not reach statistical significance for the 50–50 criteria (3.64; 0.78–17.02). The 50–50 criteria (16.45; 3.50–77.25) and PHLF (13.80; 4.27–44.61) were identified as powerful, independent predictors of mortality. This association was less strong for the MELD score (2.86; 0.98–8.31).

Conclusion

Postoperative clinical risk scores are associated independently with outcome after hepatic resection. Owing to lack of sensitivity only the MELD score can be recommended for early prediction of overall morbidity, whereas the MELD score and the PHLF enabled adequate risk stratification regarding perioperative mortality.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Langenbuch C. Ein Fall von Resecktion eines linksseitigen Schnurlappens der Leber. Berl Klin Wochenschr. 1888;25:37.

    Google Scholar 

  2. Ong GB, Lee NW. Hepatic resection. Br J Surg. 1975;62:421–30.

    Article  PubMed  CAS  Google Scholar 

  3. Foster JH, Berman MM. Solid liver tumors. Major Probl Clin Surg. 1977;22:1–342.

    PubMed  CAS  Google Scholar 

  4. Jarnagin WR, Gonen M, Fong Y, DeMatteo RP, Ben-Porat L, Little S, et al. Improvement in perioperative outcome after hepatic resection: analysis of 1,803 consecutive cases over the past decade. Ann Surg. 2002;236:397–406.

    Article  PubMed  Google Scholar 

  5. Poon RT, Fan ST, Lo CM, Liu CL, Lam CM, Yuen WK, et al. Improving perioperative outcome expands the role of hepatectomy in management of benign and malignant hepatobiliary diseases: analysis of 1222 consecutive patients from a prospective database. Ann Surg. 2004;240:698–708.

    PubMed  Google Scholar 

  6. Imamura H, Seyama Y, Kokudo N, Maema A, Sugawara Y, Sano K, et al. One thousand fifty-six hepatectomies without mortality in 8 years. Arch Surg. 2003;138:1198–206.

    Article  PubMed  Google Scholar 

  7. Belghiti J, Hiramatsu K, Benoist S, Massault P, Sauvanet A, Farges O. Seven hundred forty-seven hepatectomies in the 1990s: an update to evaluate the actual risk of liver resection. J Am Coll Surg. 2000;191:38–46.

    Article  PubMed  CAS  Google Scholar 

  8. Reissfelder C, Rahbari NN, Koch M, Kofler B, Sutedja N, Elbers H, et al. Postoperative course and clinical significance of biochemical blood tests following hepatic resection. Br J Surg. 2011;98:836–44.

    Article  PubMed  CAS  Google Scholar 

  9. Child CG II, Turcotte JG. Surgery and portal hypertension. In: Child CG III, editors. The liver and portal hypertension. Philadelphia, PA: Saunders; 1964.

  10. Malinchoc M, Kamath PS, Gordon FD, Peine CJ, Rank J, ter Borg PC. A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts. Hepatology. 2000;31:864–71.

    Article  PubMed  CAS  Google Scholar 

  11. Kamath PS, Wiesner RH, Malinchoc M, Kremers W, Therneau TM, Kosberg CL, et al. A model to predict survival in patients with end-stage liver disease. Hepatology. 2001;33:464–70.

    Article  PubMed  CAS  Google Scholar 

  12. Cucchetti A, Ercolani G, Cescon M, Ravaioli M, Zanello M, Del Gaudio M, et al. Recovery from liver failure after hepatectomy for hepatocellular carcinoma in cirrhosis: meaning of the model for end-stage liver disease. J Am Coll Surg. 2006;203:670–6.

    Article  PubMed  Google Scholar 

  13. Balzan S, Belghiti J, Farges O, Ogata S, Sauvanet A, Delefosse D, et al. The “50–50 criteria” on postoperative day 5: an accurate predictor of liver failure and death after hepatectomy. Ann Surg. 2005;242:824–8.

    Article  PubMed  Google Scholar 

  14. Rahbari NN, Garden OJ, Padbury R, Brooke-Smith M, Crawford M, Adam R, et al. Posthepatectomy liver failure: a definition and grading by the International Study Group of Liver Surgery (ISGLS). Surgery. 2011;149:713–24.

    Article  PubMed  Google Scholar 

  15. Rahbari NN, Koch M, Zimmermann JB, Brooke-Smith M, Crawford M, Adam R, et al. Infrahepatic inferior vena cava clamping for reduction of central venous pressure and blood loss during hepatic resection: a randomized controlled trial. Ann Surg. 2011;253:1102–10.

    Article  PubMed  Google Scholar 

  16. Reissfelder C, Rahbari NN, Koch M, Ulrich A, Pfeilschifter I, Waltert A, et al. Validation of prognostic scoring systems for patients undergoing resection of colorectal cancer liver metastases. Ann Surg Oncol. 2009;16:3279–88.

    Article  PubMed  Google Scholar 

  17. Rahbari NN, Wente MN, Schemmer P, Diener MK, Hoffmann K, Motschall E, et al. Systematic review and meta-analysis of the effect of portal triad clamping on outcome after hepatic resection. Br J Surg. 2008;95:424–32.

    Article  PubMed  CAS  Google Scholar 

  18. Rahbari NN, Koch M, Schmidt T, Motschall E, Bruckner T, Weidmann K, et al. Meta-analysis of the clamp-crushing technique for transection of the parenchyma in elective hepatic resection: back to where we started? Ann Surg Oncol. 2009;16:630–9.

    Article  PubMed  Google Scholar 

  19. Schmidt T, Koch M, Antolovic D, Reissfelder C, Schmitz-Winnenthal FH, Rahbari NN, et al. Influence of two different resection techniques (conventional liver resection versus anterior approach) of liver metastases from colorectal cancer on hematogenous tumor cell dissemination—prospective randomized multicenter trial. BMC Surg. 2008;8:6.

    Google Scholar 

  20. Rahbari NN, Zimmermann JB, Koch M, Bruckner T, Schmidt T, Elbers H, et al. IVC CLAMP: infrahepatic inferior vena cava clamping during hepatectomy—a randomised controlled trial in an interdisciplinary setting. Trials. 2009;10:94.

    Google Scholar 

  21. Bedossa P, Poynard T. An algorithm for the grading of activity in chronic hepatitis C. The METAVIR Cooperative Study Group. Hepatology. 1996;24:289–93.

    Article  PubMed  CAS  Google Scholar 

  22. D’Alessandro AM, Kalayoglu M, Sollinger HW, Hoffmann RM, Reed A, Knechtle SJ, et al. The predictive value of donor liver biopsies for the development of primary nonfunction after orthotopic liver transplantation. Transplantation. 1991;51:157–63.

    Article  PubMed  Google Scholar 

  23. Strasberg SM, Belghiti J, Clavien PA, Gadzijev E, Garden JO, Lau W-Y, et al. The Brisbane 2000 terminology of liver anatomy and resections. HPB. 2000;2:333–9.

    Google Scholar 

  24. Koch M, Garden OJ, Padbury R, Rahbari NN, Adam R, Capussotti L, et al. Bile leakage after hepatobiliary and pancreatic surgery: a definition and grading of severity by the International Study Group of Liver Surgery. Surgery. 2011;149:680–8.

    Article  PubMed  Google Scholar 

  25. Bismuth H, Houssin D, Mazmanian G. Postoperative liver insufficiency: prevention and management. World J Surg. 1983;7:505–10.

    Article  PubMed  CAS  Google Scholar 

  26. Schneider PD. Preoperative assessment of liver function. Surg Clin North Am. 2004;84:355–73.

    Article  PubMed  Google Scholar 

  27. Taketomi A, Kitagawa D, Itoh S, Harimoto N, Yamashita Y, Gion T, et al. Trends in morbidity and mortality after hepatic resection for hepatocellular carcinoma: an institute’s experience with 625 patients. J Am Coll Surg. 2007;204:580–7.

    Article  PubMed  Google Scholar 

  28. Freeman RB Jr, Wiesner RH, Harper A, McDiarmid SV, Lake J, Edwards E, et al. The new liver allocation system: moving toward evidence-based transplantation policy. Liver Transpl. 2002;8:851–8.

    Article  PubMed  Google Scholar 

  29. Schroeder RA, Marroquin CE, Bute BP, Khuri S, Henderson WG, Kuo PC. Predictive indices of morbidity and mortality after liver resection. Ann Surg. 2006;243:373–9.

    Article  PubMed  Google Scholar 

  30. Hsu KY, Chau GY, Lui WY, Tsay SH, King KL, Wu CW. Predicting morbidity and mortality after hepatic resection in patients with hepatocellular carcinoma: the role of Model for End-Stage Liver Disease score. World J Surg. 2009;33:2412–9.

    Article  PubMed  Google Scholar 

  31. Cucchetti A, Ercolani G, Vivarelli M, Cescon M, Ravaioli M, La Barba G, et al. Impact of model for end-stage liver disease (MELD) score on prognosis after hepatectomy for hepatocellular carcinoma on cirrhosis. Liver Transpl. 2006;12:966–71.

    Article  PubMed  Google Scholar 

  32. Teh SH, Sheppard BC, Schwartz J, Orloff SL. Model for End-stage Liver Disease score fails to predict perioperative outcome after hepatic resection for hepatocellular carcinoma in patients without cirrhosis. Am J Surg. 2008;195:697–701.

    Article  PubMed  Google Scholar 

  33. Wei AC, Tung-Ping PR, Fan ST, Wong J. Risk factors for perioperative morbidity and mortality after extended hepatectomy for hepatocellular carcinoma. Br J Surg. 2003;90:33–41.

    Article  PubMed  CAS  Google Scholar 

  34. Paugam-Burtz C, Janny S, Delefosse D, Dahmani S, Dondero F, Mantz J, et al. Prospective validation of the “fifty-fifty” criteria as an early and accurate predictor of death after liver resection in intensive care unit patients. Ann Surg. 2009;249:124–8.

    Article  PubMed  Google Scholar 

  35. Mullen JT, Ribero D, Reddy SK, Donadon M, Zorzi D, Gautam S, et al. Hepatic insufficiency and mortality in 1,059 noncirrhotic patients undergoing major hepatectomy. J Am Coll Surg. 2007;204:854–62.

    Article  PubMed  Google Scholar 

  36. Martin RC 2nd, Jarnagin WR, Fong Y, Biernacki P, Blumgart LH, DeMatteo RP. The use of fresh frozen plasma after major hepatic resection for colorectal metastasis: is there a standard for transfusion? J Am Coll Surg. 2003;196:402–9.

    Article  PubMed  Google Scholar 

  37. Stockmann M, Lock JF, Riecke B, Heyne K, Martus P, Fricke M, et al. Prediction of postoperative outcome after hepatectomy with a new bedside test for maximal liver function capacity. Ann Surg. 2009;250:119–25.

    Article  PubMed  Google Scholar 

  38. Stockmann M, Lock JF, Malinowski M, Niehues SM, Seehofer D, Neuhaus P. The LiMAx test: a new liver function test for predicting postoperative outcome in liver surgery. HPB (Oxford). 2010;12:139–46.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany

    Nuh N. Rahbari MD, Christoph Reissfelder MD, Moritz Koch MD, Heike Elbers MD, Fabian Striebel, Markus W. Büchler MD & Jürgen Weitz MD

Authors
  1. Nuh N. Rahbari MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christoph Reissfelder MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Moritz Koch MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Heike Elbers MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Fabian Striebel
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Markus W. Büchler MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jürgen Weitz MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Christoph Reissfelder MD or Jürgen Weitz MD.

Additional information

N. N. Rahbari and C. Reissfelder contributed equally to this study.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Rahbari, N.N., Reissfelder, C., Koch, M. et al. The Predictive Value of Postoperative Clinical Risk Scores for Outcome After Hepatic Resection: A Validation Analysis in 807 Patients. Ann Surg Oncol 18, 3640–3649 (2011). https://doi.org/10.1245/s10434-011-1829-6

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-011-1829-6

Keywords

Search

Navigation