Carlo Sposito1,2, Michela Monteleone1, Luca Aldrighetti3, Umberto Cillo4, Raffaele Dalla Valle5, Alfredo Guglielmi6, Giuseppe Maria Ettorre7, Alessandro Ferrero8, Fabrizio Di Benedetto9, Giorgio Ettore Rossi10, Luciano De Carlis11,12, Felice Giuliante13, Vincenzo Mazzaferro14,15. 1. Department of Gastrointestinal Surgery and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori Di Milano, Via Venezian 1, 20133, Milan, Italy. 2. Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy. 3. Hepatobiliary Surgery, IRCCS San Raffaele Hospital, Milan, Italy. 4. Hepatobiliary Surgery and Liver Transplantation Unit, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padua, Italy. 5. Department of Medicine and Surgery, University of Parma, Parma, Italy. 6. Department of Hepatobiliary Surgery, G.B. Rossi Hospital, University of Verona, Verona, Italy. 7. Division of General Surgery and Liver Transplantation, S. Camillo Hospital, Rome, Italy. 8. Department of HPB and Digestive Surgery, Ospedale Mauriziano Umberto I, Turin, Italy. 9. Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy. 10. Liver Transplant Unit, Ospedale Maggiore Policlinico, Milan, Italy. 11. Surgical and Transplant Department, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy. 12. School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy. 13. Hepatobiliary Surgery Unit, A. Gemelli Hospital, Università Cattolica del Sacro Cuore, Rome, Italy. 14. Department of Gastrointestinal Surgery and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori Di Milano, Via Venezian 1, 20133, Milan, Italy. vincenzo.mazzaferro@istitutotumori.mi.it. 15. Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy. vincenzo.mazzaferro@istitutotumori.mi.it.
Abstract
BACKGROUND: Post-hepatectomy liver failure (PHLF) represents the most frequent complication after liver surgery, and the most common cause of morbidity and mortality. Aim of the study is to identify the predictors of PHLF after mini-invasive liver surgery in cirrhosis and chronic liver disease, and to develop a model for risk prediction. METHODS: The present study is a multicentric prospective cohort study on 490 consecutive patients who underwent mini-invasive liver resection from the Italian Registry of Mini-invasive Liver Surgery (I go MILS). Retrospective additional biochemical and clinical data were collected. RESULTS: On 490 patients (26.5% females), PHLF occurred in 89 patients (18.2%). The only independent predictors of PHLF were Albumin-Bilirubin (ALBI) score (OR 3.213; 95% CI 1.661-6.215; p < .0.0001) and presence of ascites (OR 3.320; 95% CI 1.468-7.508; p = 0.004). Classification and regression tree (CART) modeling led to the identification of three risk groups: PHLF occurred in 23/217 patients with ALBI grade 1 (10.6%, low risk group), in 54/254 patients with ALBI score 2 or 3 and absence of ascites (21.3%, intermediate risk group) and in 12/19 patients with ALBI score 2 or 3 and evidence of ascites (63.2%, high risk group), p < 0.0001. The three groups showed a corresponding increase in postoperative complications (20.0%, 27.5% and 66.7%), Comprehensive Complication Index (5.1 ± 11.1, 6.0 ± 10.9 and 18.8 ± 18.9) and hospital stay (6.0 ± 4.0, 6.0 ± 6.0 and 8.0 ± 5.0 days). CONCLUSION: The risk of PHLF can be stratified by determining two easily available preoperative factors: ALBI and ascites. This model of risk prediction offers an objective instrument for a correct clinical decision-making.
BACKGROUND: Post-hepatectomy liver failure (PHLF) represents the most frequent complication after liver surgery, and the most common cause of morbidity and mortality. Aim of the study is to identify the predictors of PHLF after mini-invasive liver surgery in cirrhosis and chronic liver disease, and to develop a model for risk prediction. METHODS: The present study is a multicentric prospective cohort study on 490 consecutive patients who underwent mini-invasive liver resection from the Italian Registry of Mini-invasive Liver Surgery (I go MILS). Retrospective additional biochemical and clinical data were collected. RESULTS: On 490 patients (26.5% females), PHLF occurred in 89 patients (18.2%). The only independent predictors of PHLF were Albumin-Bilirubin (ALBI) score (OR 3.213; 95% CI 1.661-6.215; p < .0.0001) and presence of ascites (OR 3.320; 95% CI 1.468-7.508; p = 0.004). Classification and regression tree (CART) modeling led to the identification of three risk groups: PHLF occurred in 23/217 patients with ALBI grade 1 (10.6%, low risk group), in 54/254 patients with ALBI score 2 or 3 and absence of ascites (21.3%, intermediate risk group) and in 12/19 patients with ALBI score 2 or 3 and evidence of ascites (63.2%, high risk group), p < 0.0001. The three groups showed a corresponding increase in postoperative complications (20.0%, 27.5% and 66.7%), Comprehensive Complication Index (5.1 ± 11.1, 6.0 ± 10.9 and 18.8 ± 18.9) and hospital stay (6.0 ± 4.0, 6.0 ± 6.0 and 8.0 ± 5.0 days). CONCLUSION: The risk of PHLF can be stratified by determining two easily available preoperative factors: ALBI and ascites. This model of risk prediction offers an objective instrument for a correct clinical decision-making.
Authors: Giovanni Marasco; Luigina Vanessa Alemanni; Antonio Colecchia; Davide Festi; Franco Bazzoli; Giuseppe Mazzella; Marco Montagnani; Francesco Azzaroli Journal: J Clin Med Date: 2021-05-08 Impact factor: 4.241