OBJECTIVE: To assess the ability of preoperative biological parameters to predict a fatal outcome after a major liver resection in patients without cirrhosis. DESIGN: Retrospective descriptive cohort study. SETTING: Department of Digestive Surgery and Transplantation, University of Strasbourg. PATIENTS: From January 1, 2004, through December 31, 2007, 67 consecutive patients underwent resection of at least 4 contiguous liver segments. MAIN OUTCOME MEASURES: Perioperative data were prospectively recorded, and predictors of postoperative mortality rate and liver failure were analyzed. RESULTS: Five patients (7%) died after a mean (SD) of 32.4 (11.8) postoperative days. The overall morbidity was 73% (49 patients). Univariate analysis revealed that a preoperative alanine aminotransferase blood level greater than 40 U/L (to convert to microkatals per liter, multiply by 0.0167), a preoperative prothrombin ratio less than 70%, a preoperative Indocyanine green retention rate at 15 minutes of greater than 15%, preoperative biliary drainage, and performance of extrahepatic bile duct resection significantly predict the occurrence of in-hospital death. The number of preoperative biological parameters in each patient significantly increased the mortality rate. Indeed, the mortalities were 0%, 3%, and 67% in patients presenting with none, 1, and 2 or more risk factors, respectively. CONCLUSIONS: This study shows that preoperative liver tests and function can predict postoperative fatal outcome in patients presenting with biliary carcinomas and requiring a major liver resection. On the basis of these preoperative biological parameters, a decision-making algorithm is provided.
OBJECTIVE: To assess the ability of preoperative biological parameters to predict a fatal outcome after a major liver resection in patients without cirrhosis. DESIGN: Retrospective descriptive cohort study. SETTING: Department of Digestive Surgery and Transplantation, University of Strasbourg. PATIENTS: From January 1, 2004, through December 31, 2007, 67 consecutive patients underwent resection of at least 4 contiguous liver segments. MAIN OUTCOME MEASURES: Perioperative data were prospectively recorded, and predictors of postoperative mortality rate and liver failure were analyzed. RESULTS: Five patients (7%) died after a mean (SD) of 32.4 (11.8) postoperative days. The overall morbidity was 73% (49 patients). Univariate analysis revealed that a preoperative alanine aminotransferase blood level greater than 40 U/L (to convert to microkatals per liter, multiply by 0.0167), a preoperative prothrombin ratio less than 70%, a preoperative Indocyanine green retention rate at 15 minutes of greater than 15%, preoperative biliary drainage, and performance of extrahepatic bile duct resection significantly predict the occurrence of in-hospital death. The number of preoperative biological parameters in each patient significantly increased the mortality rate. Indeed, the mortalities were 0%, 3%, and 67% in patients presenting with none, 1, and 2 or more risk factors, respectively. CONCLUSIONS: This study shows that preoperative liver tests and function can predict postoperative fatal outcome in patients presenting with biliary carcinomas and requiring a major liver resection. On the basis of these preoperative biological parameters, a decision-making algorithm is provided.
Authors: Srinevas K Reddy; Andrew S Barbas; Ryan S Turley; Jennifer L Steel; Allan Tsung; J Wallis Marsh; David A Geller; Bryan M Clary Journal: HPB (Oxford) Date: 2011-07 Impact factor: 3.647