Complications of Elective Liver Resections in a Center With Low Mortality: A Simple Score to Predict Morbidity | Gastrointestinal Surgery | JAMA Surgery | JAMA Network
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Chowdhury MM, Dagash H, Pierro A. A systematic review of the impact of volume of surgery and specialization on patient outcome.  Br J Surg. 2007;94(2):145-16117256810PubMedGoogle ScholarCrossref
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(3):373-37916495703PubMedGoogle ScholarCrossref
Csikesz NG, Simons JP, Tseng JF, Shah SA. Surgical specialization and operative mortality in hepato-pancreatico-biliary (HPB) surgery.  J Gastrointest Surg. 2008;12(9):1534-153918612710PubMedGoogle ScholarCrossref
Imamura H, Shimada R, Kubota M,  et al.  Preoperative portal vein embolization: an audit of 84 patients.  Hepatology. 1999;29(4):1099-110510094953PubMedGoogle ScholarCrossref
Azoulay D, Castaing D, Krissat J,  et al.  Percutaneous portal vein embolization increases the feasibility and safety of major liver resection for hepatocellular carcinoma in injured liver.  Ann Surg. 2000;232(5):665-67211066138PubMedGoogle ScholarCrossref
Abdalla EK, Barnett CC, Doherty D, Curley SA, Vauthey JN. Extended hepatectomy in patients with hepatobiliary malignancies with and without preoperative portal vein embolization.  Arch Surg. 2002;137(6):675-68112049538PubMedGoogle ScholarCrossref
Bismuth H, Majno PE. Hepatobiliary surgery.  J Hepatol. 2000;32(1):(suppl)  208-22410728806PubMedGoogle ScholarCrossref
Kubota K, Makuuchi M, Kusaka K,  et al.  Measurement of liver volume and hepatic functional reserve as a guide to decision-making in resectional surgery for hepatic tumors.  Hepatology. 1997;26(5):1176-11819362359PubMedGoogle Scholar
Dimick JB, Wainess RM, Cowan JA, Upchurch GR Jr, Knol JA, Colletti LM. National trends in the use and outcomes of hepatic resection.  J Am Coll Surg. 2004;199(1):31-3815217626PubMedGoogle ScholarCrossref
Andres A, Majno PE, Morel P,  et al.  Improved long-term outcome of surgery for advanced colorectal liver metastases: reasons and implications for management on the basis of a severity score.  Ann Surg Oncol. 2008;15(1):134-14317909911PubMedGoogle ScholarCrossref
Seium Y, Stupp R, Ruhstaller T,  et al.  Oxaliplatin combined with irinotecan and 5-fluorouracil/leucovorin (OCFL) in metastatic colorectal cancer: a phase I-II study.  Ann Oncol. 2005;16(5):762-76615817597PubMedGoogle ScholarCrossref
Mentha G, Majno PE, Andres A, Rubbia-Brandt L, Morel P, Roth AD. Neoadjuvant chemotherapy and resection of advanced synchronous liver metastases before treatment of the colorectal primary.  Br J Surg. 2006;93(7):872-87816671066PubMedGoogle ScholarCrossref
Mentha G, Majno P, Terraz S,  et al.  Treatment strategies for the management of advanced colorectal liver metastases detected synchronously with the primary tumour.  Eur J Surg Oncol. 2007;33:(suppl 2)  S76-S8318006267PubMedGoogle ScholarCrossref
Mentha G, Roth AD, Terraz S,  et al.  “Liver first” approach in the treatment of colorectal cancer with synchronous liver metastases.  Dig Surg. 2008;25(6):430-43519212115PubMedGoogle ScholarCrossref
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(1):38-4610898182PubMedGoogle ScholarCrossref
Shimada M, Matsumata T, Akazawa K,  et al.  Estimation of risk of major complications after hepatic resection.  Am J Surg. 1994;167(4):399-4038179084PubMedGoogle ScholarCrossref
Cescon M, Vetrone G, Grazi GL,  et al.  Trends in perioperative outcome after hepatic resection: analysis of 1500 consecutive unselected cases over 20 years.  Ann Surg. 2009;249(6):995-100219474679PubMedGoogle ScholarCrossref
Taniguchi H, Takahashi T. Analysis of 210 elective hepatic resections.  Hepatogastroenterology. 1997;44(18):1624-16319427034PubMedGoogle Scholar
Sitzmann JV, Greene PS. Perioperative predictors of morbidity following hepatic resection for neoplasm: a multivariate analysis of a single surgeon experience with 105 patients.  Ann Surg. 1994;219(1):13-178297171PubMedGoogle ScholarCrossref
Capussotti L, Polastri R. Operative risks of major hepatic resections.  Hepatogastroenterology. 1998;45(19):184-1909496510PubMedGoogle Scholar
Savage AP, Malt RA. Elective and emergency hepatic resection: determinants of operative mortality and morbidity.  Ann Surg. 1991;214(6):689-6951741648PubMedGoogle ScholarCrossref
Sima CS, Jarnagin WR, Fong Y,  et al.  Predicting the risk of perioperative transfusion for patients undergoing elective hepatectomy.  Ann Surg. 2009;250(6):914-92119953711PubMedGoogle ScholarCrossref
Slankamenac K, Breitenstein S, Held U, Beck-Schimmer B, Puhan MA, Clavien PA. Development and validation of a prediction score for postoperative acute renal failure following liver resection.  Ann Surg. 2009;250(5):720-72819809295PubMedGoogle ScholarCrossref
Roche AM, Miller TE, Gan TJ. Goal-directed fluid management with trans-oesophageal Doppler.  Best Pract Res Clin Anaesthesiol. 2009;23(3):327-33419862891PubMedGoogle ScholarCrossref
Schober P, Loer SA, Schwarte LA. Transesophageal Doppler devices: a technical review.  J Clin Monit Comput. 2009;23(6):391-40119842049PubMedGoogle ScholarCrossref
Berney T, Mentha G, Morel P. Total vascular exclusion of the liver for the resection of lesions in contact with the vena cava or the hepatic veins.  Br J Surg. 1998;85(4):485-4889607528PubMedGoogle ScholarCrossref
Clavien PA, Sanabria JR, Strasberg SM. Proposed classification of complications of surgery with examples of utility in cholecystectomy.  Surgery. 1992;111(5):518-5261598671PubMedGoogle Scholar
Balzan S, Belghiti J, Farges O,  et al.  The “50-50 criteria” on postoperative day 5: an accurate predictor of liver failure and death after hepatectomy.  Ann Surg. 2005;242(6):824-82916327492PubMedGoogle ScholarCrossref
Lancaster RT, Tanabe KK, Schifftner TL,  et al.  Liver resection in veterans affairs and selected university medical centers: results of the patient safety in surgery study.  J Am Coll Surg. 2007;204(6):1242-125117544082PubMedGoogle ScholarCrossref
Benzoni E, Cojutti A, Lorenzin D,  et al.  Liver resective surgery: a multivariate analysis of postoperative outcome and complication.  Langenbecks Arch Surg. 2007;392(1):45-5416983576PubMedGoogle ScholarCrossref
Ghobrial RM, Freise CE, Trotter JF,  et al; A2ALL Study Group.  Donor morbidity after living donation for liver transplantation.  Gastroenterology. 2008;135(2):468-47618505689PubMedGoogle ScholarCrossref
Dimick JB, Pronovost PJ, Cowan JA Jr, Lipsett PA. Postoperative complication rates after hepatic resection in Maryland hospitals.  Arch Surg. 2003;138(1):41-4612511147PubMedGoogle ScholarCrossref
Pelosi P, Jaber S. Noninvasive respiratory support in the perioperative period.  Curr Opin Anaesthesiol. 2010;23(2):233-23820019602PubMedGoogle ScholarCrossref
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey.  Ann Surg. 2004;240(2):205-21315273542PubMedGoogle ScholarCrossref
Mentha G, Terraz S, Morel P,  et al.  Dangerous halo after neoadjuvant chemotherapy and two-step hepatectomy for colorectal liver metastases.  Br J Surg. 2009;96(1):95-10319109800PubMedGoogle ScholarCrossref
Tanabe G, Sakamoto M, Akazawa K,  et al.  Intraoperative risk factors associated with hepatic resection.  Br J Surg. 1995;82(9):1262-12657552014PubMedGoogle ScholarCrossref
Mentha G, Huber O, Robert J, Klopfenstein C, Egeli R, Rohner A. Elective hepatic resection in the elderly.  Br J Surg. 1992;79(6):557-5591611452PubMedGoogle ScholarCrossref
di Sebastiano P, Festa L, Büchler MW, di Mola FF. Surgical aspects in management of hepato-pancreatico-biliary tumours in the elderly.  Best Pract Res Clin Gastroenterol. 2009;23(6):919-92319942168PubMedGoogle ScholarCrossref
Adam R, Frilling A, Elias D,  et al; LiverMetSurvey Centres.  Liver resection of colorectal metastases in elderly patients.  Br J Surg. 2010;97(3):366-37620101645PubMedGoogle ScholarCrossref
Original Article
Nov 2011

Complications of Elective Liver Resections in a Center With Low Mortality: A Simple Score to Predict Morbidity

Author Affiliations

Author Affiliations: Departments of Visceral and Transplantation Surgery (Drs Andres, Toso, Moldovan, Morel, Majno, and Mentha), Anesthesiology (Drs Schiffer and Klopfenstein), Clinical Pathology (Dr Rubbia-Brandt), and Radiology (Dr Terraz), Geneva University Hospitals, Geneva, Switzerland.

Arch Surg. 2011;146(11):1246-1252. doi:10.1001/archsurg.2011.175

Objective To develop a score predicting the morbidity of liver resections in a center with low mortality.

Design, Setting, and Patients The study was based on a prospective database of all liver resections performed at the Geneva University Hospitals between January 1, 1991, and October 30, 2009 (a total of 726 elective liver resections in 689 patients). Perioperative complications and their severity were graded according to the original classification by Clavien et al. Variables independently associated with the occurrence of complications were identified using a linear regression analysis model. A score was computed with all independent variables in an assessment population including two-thirds of the liver resections and was further validated in a population including one-third of the liver resections.

Results Overall mortality was 0.7% (5 of 726 liver resections). We recorded 375 different complications in 259 hepatic resections (36% of resections had ≥1 complication). In the assessment group, resection of 3 or more segments, an American Society of Anesthesiologists score of 3 or higher, and resection for a malignant neoplasm independently predicted the risk of complications. A score integrating these 3 factors significantly predicted the risk of postoperative complications. The score also correlated with the occurrence of major complications.

Conclusion The score allows for identification of patients most susceptible to complications, in whom efforts against specific postoperative morbidities can be concentrated.