Indication of the Extent of Hepatectomy for Hepatocellular Carcinoma on Cirrhosis by a Simple Algorithm Based on Preoperative Variables | Gastrointestinal Surgery | JAMA Surgery | JAMA Network
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Original Article
January 19, 2009

Indication of the Extent of Hepatectomy for Hepatocellular Carcinoma on Cirrhosis by a Simple Algorithm Based on Preoperative Variables

Author Affiliations

Author Affiliations: Liver and Multiorgan Transplant Unit, Department of Surgery and Transplantation, University of Bologna, Bologna (Drs Cescon, Cucchetti, Grazi, Ercolani, Zanello, Ravaioli, and Pinna); and Unit of Surgical Oncology, Institute for Cancer Research and Treatment, Candiolo, Torino, Italy (Drs Ferrero, Vigan[[ograve]], and Capussotti).

Arch Surg. 2009;144(1):57-63. doi:10.1001/archsurg.2008.522

Objective  To produce a model indicating the extent of hepatectomy for hepatocellular carcinoma on cirrhosis based on easily available preoperative data.

Design  Retrospective study based on multicenter prospectively updated databases.

Setting  Two tertiary referral centers specializing in hepatobiliary surgery.

Patients  A total of 466 patients undergoing hepatectomy for hepatocellular carcinoma on cirrhosis between 1995 and 2006.

Main Outcome Measures  To create a decision tree for safe liver resection based on factors affecting irreversible postoperative liver failure (IPLF).

Results  A total of 23 patients (4.9%) developed IPLF. The model for end-stage liver disease (MELD) score (categorized as <9, 9-10, and >10; P < .05 for all comparisons) and extent of hepatectomy were independent predictors of IPLF. In patients with a MELD score of less than 9, the IPLF rate was 0.4%. In patients with a MELD score of 9 or 10, the IPLF rate was 1.2% for resections of less than 1 segment, 5.1% for segmentectomies or bisegmentectomies, and 11.1% for major hepatectomies. In this category of MELD, serum sodium levels identified a low-risk group (sodium ≥140 mEq/L; to convert to millimoles per liter, multiply by 1.0) not experiencing IPLF and a high-risk group (sodium <140 mEq/L) in which resections of less than 1 segment led to an IPLF rate of 2.5% and resections of 1 segment or more led to an IPLF rate of more than 5% (P < .05). In patients with a MELD score of more than 10, the IPLF rate was more than 15% in all types of hepatectomies.

Conclusion  A simple algorithm based on the MELD score and serum sodium level can indicate the maximum tolerable extent of hepatectomy for hepatocellular carcinoma on cirrhosis.