Reductions in post‐hepatectomy liver failure and related mortality after implementation of the LiMAx algorithm in preoperative work‐up: a single‐centre analysis of 1170 hepatectomies of one or more segments (original) (raw)
Related papers
The LiMAx Test as Selection Criteria in Minimally Invasive Liver Surgery
Journal of Clinical Medicine
Background: Liver failure is a crucial predictor for relevant morbidity and mortality after hepatic surgery. Hence, a good patient selection is mandatory. We use the LiMAx test for patient selection for major or minor liver resections in robotic and laparoscopic liver surgery and share our experience here. Patients and methods: We identified patients in the Magdeburg registry of minimally invasive liver surgery (MD-MILS) who underwent robotic or laparoscopic minor or major liver surgery and received a LiMAx test for preoperative evaluation of the liver function. This cohort was divided in two groups: patients with normal (LiMAx normal) and decreased (LiMAx decreased) liver function measured by the LiMAx test. Results: Forty patients were selected from the MD-MILS regarding the selection criteria (LiMAx normal, n = 22 and LiMAx decreased, n = 18). Significantly more major liver resections were performed in the LiMAx normal vs. the LiMAx decreased group (13 vs. 2; p = 0.003). Hence, t...
Annals of Surgery, 2021
Objective: To compare different criteria for post-hepatectomy liver failure (PHLF) and evaluate the association between International Study Group of Liver Surgery (ISGLS) PHLF and the Comprehensive Complication Index (CCI)” and 90-day mortality. Summary of Background Data: PHLF is a serious complication following hepatic resection. Multiple criteria have been developed to characterize PHLF. Methods: Adults who underwent major hepatectomies at twelve international centers (2010–2020) were included. We identified patients who met criteria for PHLF based on three definitions: 1) ISGLS, 2) Balzan (INR > 1.7 and bilirubin > 2.92mg/dL) or 3) Mullen (peak bilirubin >7mg/dL). We compared the 90-day mortality and major morbidity predicted by each definition. We then used logistic regression to determine the odds of CCI>40 and 90-day mortality associated with ISGLS grades. Results: Among 1646 included patients, 19 (1.1%) met Balzan, 68 (4.1%) met Mullen, and 444 (27.0%) met ISGLS ...
Scientific Reports, 2020
The aim of this study was to assess and compare the discriminatory performance of well-known risk assessment scores in predicting mortality risk after extended hepatectomy (EH). A series of 250 patients who underwent EH (≥5 segments resection) were evaluated. Aspartate aminotransferase-to-platelet ratio index (APRI), albumin to bilirubin (ALBI) grade, predictive score developed by Breitenstein et al., liver fibrosis (FIB-4) index, and Heidelberg reference lines charting were used to compute cut-off values, and the sensitivity and specificity of each risk assessment score for predicting mortality were also calculated. Major morbidity and 90-day mortality after EH increased with increasing risk scores. APRI (86%), ALBI (86%), Heidelberg score (81%), and FIB-4 index (79%) had the highest sensitivity for 90-day mortality. However, only the FIB-4 index and Heidelberg score had an acceptable specificity (70% and 65%, respectively). A two-stage risk assessment strategy (Heidelberg–FIB-4 mo...
Journal of Surgical Oncology, 2019
Background: Post hepatectomy liver failure (PHLF) is a serious complication in patients undergoing liver resection. This study hypothesized that a new pre-operative risk score developed through statistical modeling to predict PHLF could be used to stratify patients at higher risk of PHLF. Methods: Patients who underwent hepatectomy between 2008 and 2016 were included in the derivation and validation cohorts. A multivariable binary logistic regression model was performed to identify predictors of PHLF, and a prognostic score was derived. Results: A total of 1269 patients were included in the derivation cohort. PHLF was encountered in 13.1% and was associated with significantly increased 90-day mortality and prolonged post-operative hospital stay (both p < 0.001). Multivariable analysis identified the extent of surgery (p < 0.001) and pre-operative bilirubin (p = 0.015), INR (p < 0.001), and creatinine (p = 0.048) to be independent predictors of PHLF. A risk score derived from these factors returned an area under the ROC curve (AUROC) of 0.816 (p < 0.001) for an internal validation cohort (N = 453), significantly outperforming the MELD score (AUROC: 0.643). Conclusion: The PHLF risk score could be used to stratify the risk of PHLF among patients planned for hepatectomy.
Journal of hepato-biliary-pancreatic sciences, 2016
The National Clinical Database (NCD) in Japan is a nationwide registry that collects the data of more than 1,200,000 surgical cases annually from over 3,500 hospitals. Based on the NCD data, this study compared the perioperative outcomes of major laparoscopic liver resection (LLR) with those of major open liver resection (OLR) using the propensity score matching method. We collected data on 15,191 major hepatectomy cases (929 major LLR cases and 14,262 major OLR cases), and investigated the short-term outcomes in well-matched groups. In the LLR group, 30-day mortality, in-hospital mortality, and operative mortality were 0.9%, 1.7%, and 1.7% respectively. The mean blood loss in the LLR group (865.4 ± 1,148.2 ml) was significantly less than in the OLR group (1,053.8 ± 1,176.6 ml), and the median postoperative hospital stay for the LLR patients (21.37 ± 19.71 days) was significantly shorter than for the OLR patients (26.25 ± 24.53 days). The complication rate in the LLR group (16.4%) w...
Journal of Gastrointestinal Surgery, 2016
Background While minimally invasive surgery (MIS) to treat liver tumors has increased, data on perioperative outcomes of MIS relative to open liver resection (O-LR) are lacking. We sought to compare short-term outcomes among patients undergoing MIS vs. O-LR in a nationally representative database. Methods The National Surgical Quality Improvement Program database was used to identify patients undergoing hepatectomy between January 1 and December 31, 2014. Propensity score matching algorithm was used to balance differences in baseline characteristics among MIS and O-LR groups. Results A total of 3064 patients were included in the study. After propensity matching, the baseline characteristics for O-LR and MIS groups were comparable (minimum p value=0.12). Incidence of superficial surgical site infections, intraoperative or postoperative blood transfusions, and pulmonary embolism was lower among patients in MIS group compared to O-LR (p<0.02). Liver failure and biliary leakage were also less frequent among patients undergoing MIS (p<0.01). Similarly, MIS was associated with a shorter length of hospital stay (LOS) compared to O-LR (p<0.001). Of note, 30-day postoperative mortality and readmission were comparable between the two groups. Conclusions Patients undergoing MIS had a lower postoperative morbidity and shorter LOS compared with patients undergoing O-LR. MIS is safe and may be associated with improved short-term outcomes following hepatic surgery.
HPB, 2016
Background: Estimation of the future liver remnant function (eFLRF) can avoid post-hepatectomy liver failure (PHLF). In a previous study, a cutoff value of 2.3%/min/m 2 for eFLRF was a better predictor of PHLF than future liver remnant volume (FLRV%). In this prospective interventional study, investigating a management strategy aimed at avoiding PHLF, this cutoff value was the sole criterion assessing eligibility for hepatectomy, with or without portal vein occlusion (PVO). Methods: In 100 consecutive patients, eFLRF was determined using the formula: eFLRF = FLRV % × total liver function (TLF). Group 1 (eFLRF >2.3%/min/m 2) underwent hepatectomy without preoperative intervention. Group 2 (eFLRF <2.3%/min/m 2) underwent PVO and re-evaluation of eFLRF at 4-6 weeks. Hepatectomy was performed if eFLRF had increased to >2.3%/min/m 2 , but was considered contraindicated if the value remained lower. Results: In group 1 (n = 93), 1 patient developed grade B PHLF. In group 2 (n = 7) no PHLF was recorded. Postoperative recovery of TLF in patients with preoperative eFLRF <2.3%/min/m 2 occurred more rapidly when PVO had been performed. Conclusion: A predefined cutoff for preoperatively calculated eFLRF can be used as a tool for selecting patients prior to hepatectomy, with or without PVO, thus avoiding PHLF and PHLF-related mortality.
2019
95 Introduction 96 Objective of this study 96 Methods 97 Inclusion criteria 97 Preoperative evaluation 97 Portal vein occlusion 98 Intraoperative measurements 99 Postoperative evaluation – detection of PHLF 99 Comparing the interventional and observational studies 99 Recovery of liver function after hepatectomy 100 Statistical analysis 101 Results 101 Discussion 106 The added value of eFLRF 106 Main outcome and historical comparison group 108 Portal vein occlusion 108 Faster recovery of liver function after PVO 110 Conclusion 111 References 112 Use of future liver remnant function avoids post-hepatectomy liver failure
World journal of surgery, 2018
Laparoscopic liver surgery is expanding worldwide, but further evidence is needed to assess safety and efficacy of laparoscopic major hepatectomy. The study analyzes perioperative outcomes of pure laparoscopic versus open major hepatectomies matched by the propensity score method. From 2005 to 2017, 268 major hepatectomies were performed of which 73 were laparoscopic. After a 1:1 propensity score matching, 59 laparoscopic right and left hepatectomies were compared to 59 open. The matching was based on age, gender, year of procedure, BMI, ASA score, underlying liver disease, previous abdominal surgery, type of hepatectomy, preoperative chemotherapy, number, dimension and nature of lesions. An intention-to-treat analysis and a per-protocol analysis were carried out. Mean surgical time was 315 min in the laparoscopic group and 292.5 min in the open group (p = 0.039); conversion rate in laparoscopy was 20.3%; blood loss was 480 ml (50-3000) versus 550 ml (50-2600), respectively, for lap...