Risk of liver failure after major hepatectomy for patients with hepatocellular carcinoma

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Abstract

Background/aims
Hepatectomies in cirrhotic patients are complex operative interventions. Extent of hepatectomy, in particular, has a direct relation to outcomes, with posthepatectomy liver failure (PHLF) being the main cause of morbidity and mortality. This work aimed to determine the frequency and the risk factors of PHLF in patients with hepatocellular carcinoma (HCC) undergoing resection of more than two segments of the liver.
Patients and methods
A retrospective study included all patients who underwent liver resection of more than two segments for HCC between 2013 and 2017. Preoperative parameters were evaluated and analyzed for their predictive value of PHLF, which was defined based on the 50–50 criteria [prothrombin index <50% (international normalized ratio >1.7) and serum bilirubin >50 µmol/l (2.9 mg/dl) on postoperative day 5].
Results
A total of 28 patients underwent liver resection of more than two segments for HCC. The mean age of patients was 58.86±8.11 years, with range between 26 and 68 years, and 68% of them were males. Hepatitis C virus infection was the most frequent etiology of liver disease followed by hepatitis B virus infection. Sixteen (57%) patients developed PHLF. Patients with PHLF had significantly higher age, lower serum albumin, and higher Child’s and model for end-stage liver disease (MELD) scores. Based on multivariate regression analysis, only low serum albumin and high Child’s and MELD scores were predictors for PHLF.
Conclusion
Patients with liver cirrhosis who have low serum albumin and high Child’s and MELD scores who are indicated for resection of two or more liver segments have a higher risk of postresection liver failure.

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