Boram Lee1, Jai Young Cho2, Ho-Seong Han1, Yoo-Seok Yoon1, Hae Won Lee1, Jun Suh Lee1, Moonhwan Kim1, Yeongsoo Jo1. 1. Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, South Korea. 2. Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, South Korea. jychogs@gmail.com.
Abstract
BACKGROUND: The safety of laparoscopic liver resection (LLR) in elderly patients is a matter of concern because the reduced physiologic reserve increases the risk of postoperative complications. However, there are few score systems for predicting complications after LLR in elderly patients. The aim of this study is to propose a new simplified scoring system based on the Geriatric Nutritional Risk Index (GNRI) to predict major complications after LLR in elderly patients with hepatocellular carcinoma (HCC). METHODS: We retrospectively reviewed 257 consecutive patients aged ≥ 65 years who underwent LLR for HCC between 2004 and 2019. The GNRI formula was 1.489 × serum albumin (g/L) + 41.7 × present weight/ideal weight (kg). A scoring system to predict the risk of major complications was developed by assigning points to each risk factor equal to its regression coefficient determined in the multivariable analysis. Major complications were defined as complications of Clavien-Dindo grade III or higher. RESULTS: Of the 257 patients, 219 patients were finally included in this study. Major complications occurred after LLR in 24 patients (10.9%). Multivariable analysis showed that the GNRI (hazard ratio [HR] 3.396, 95% confidence interval [CI] 1.242-9.288, P = 0.017), Child-Turcotte-Pugh score (HR 2.191, 95% CI 1.400-8.999, P = 0.036), major liver resection (HR 2.683, 95% CI 1.082-7.328, P = 0.050), and intraoperative transfusion (HR 1.802, 95% CI 1.428-7.591, P = 0.022) were independent predictors of major postoperative complications. These variables were assigned points based on their HRs, and the resulting 10-point model showed good discrimination (area under the curve 0.756, 95% CI 0.649-0.836, P = 0.001). CONCLUSION: The scoring system outperformed the GNRI for predicting major complications after LLR in elderly patients with HCC.
BACKGROUND: The safety of laparoscopic liver resection (LLR) in elderly patients is a matter of concern because the reduced physiologic reserve increases the risk of postoperative complications. However, there are few score systems for predicting complications after LLR in elderly patients. The aim of this study is to propose a new simplified scoring system based on the Geriatric Nutritional Risk Index (GNRI) to predict major complications after LLR in elderly patients with hepatocellular carcinoma (HCC). METHODS: We retrospectively reviewed 257 consecutive patients aged ≥ 65 years who underwent LLR for HCC between 2004 and 2019. The GNRI formula was 1.489 × serum albumin (g/L) + 41.7 × present weight/ideal weight (kg). A scoring system to predict the risk of major complications was developed by assigning points to each risk factor equal to its regression coefficient determined in the multivariable analysis. Major complications were defined as complications of Clavien-Dindo grade III or higher. RESULTS: Of the 257 patients, 219 patients were finally included in this study. Major complications occurred after LLR in 24 patients (10.9%). Multivariable analysis showed that the GNRI (hazard ratio [HR] 3.396, 95% confidence interval [CI] 1.242-9.288, P = 0.017), Child-Turcotte-Pugh score (HR 2.191, 95% CI 1.400-8.999, P = 0.036), major liver resection (HR 2.683, 95% CI 1.082-7.328, P = 0.050), and intraoperative transfusion (HR 1.802, 95% CI 1.428-7.591, P = 0.022) were independent predictors of major postoperative complications. These variables were assigned points based on their HRs, and the resulting 10-point model showed good discrimination (area under the curve 0.756, 95% CI 0.649-0.836, P = 0.001). CONCLUSION: The scoring system outperformed the GNRI for predicting major complications after LLR in elderly patients with HCC.
Authors: Go Wakabayashi; Daniel Cherqui; David A Geller; Joseph F Buell; Hironori Kaneko; Ho Seong Han; Horacio Asbun; Nicholas OʼRourke; Minoru Tanabe; Alan J Koffron; Allan Tsung; Olivier Soubrane; Marcel Autran Machado; Brice Gayet; Roberto I Troisi; Patrick Pessaux; Ronald M Van Dam; Olivier Scatton; Mohammad Abu Hilal; Giulio Belli; Choon Hyuck David Kwon; Bjørn Edwin; Gi Hong Choi; Luca Antonio Aldrighetti; Xiujun Cai; Sean Cleary; Kuo-Hsin Chen; Michael R Schön; Atsushi Sugioka; Chung-Ngai Tang; Paulo Herman; Juan Pekolj; Xiao-Ping Chen; Ibrahim Dagher; William Jarnagin; Masakazu Yamamoto; Russell Strong; Palepu Jagannath; Chung-Mau Lo; Pierre-Alain Clavien; Norihiro Kokudo; Jeffrey Barkun; Steven M Strasberg Journal: Ann Surg Date: 2015-04 Impact factor: 12.969