1
|
Calthorpe L, Rashidian N, Cacciaguerra AB, Conroy PC, Hibi T, Hilal MA, Hoffman D, Park KM, Wang J, Adam MA, Alseidi A. Using the Comprehensive Complication Index to Rethink the ISGLS Criteria for Post-hepatectomy Liver Failure in an International Cohort of Major Hepatectomies. Ann Surg 2023; 277:e592-e596. [PMID: 34913896 PMCID: PMC9308484 DOI: 10.1097/sla.0000000000005338] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare different criteria for post-hepatectomy liver failure (PHLF) and evaluate the association between International Study Group of Liver Surgery (ISGLS) PHLF and the Comprehensive Complication Index (CCI)" and 90-day mortality. SUMMARY OF BACKGROUND DATA PHLF is a serious complication following hepatic resection. Multiple criteria have been developed to characterize PHLF. METHODS Adults who underwent major hepatectomies at twelve international centers (2010-2020) were included. We identified patients who met criteria for PHLF based on three definitions: 1) ISGLS, 2) Balzan (INR > 1.7 and bilirubin > 2.92mg/dL) or 3) Mullen (peak bilirubin >7mg/dL). We compared the 90-day mortality and major morbidity predicted by each definition. We then used logistic regression to determine the odds of CCI>40 and 90-day mortality associated with ISGLS grades. RESULTS Among 1646 included patients, 19 (1.1%) met Balzan, 68 (4.1%) met Mullen, and 444 (27.0%) met ISGLS criteria for PHLF. Of the three definitions, the ISGLS criteria best predicted 90-day mortality (AUC = 0.72; sensitivity 69.4%). Patients with ISGLS grades B&C were at increased odds of CCI > 40 (grade B OR 4.0; 95% CI: 2.2-7.2; grade C OR 137.0; 95% CI: 59.2-317.4). Patients with ISGLS grade C were at increased odds of 90-day mortality (OR 113.6; 95% CI: 55.6-232.1). Grade A was not associated with CCI> 40 or 90-day mortality. CONCLUSIONS In this diverse international cohort of major hepatectomies, ISGLS grade A was not associated with 90-day mortality or high CCI, calling into question the current classification of patients in this group as having clinically significant PHLF.
Collapse
Affiliation(s)
- Lucia Calthorpe
- School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Nikdokht Rashidian
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Andrea Benedetti Cacciaguerra
- Department of Surgery, Poliambulanza Foundation Hospital, Brescia, Italy
- Department of Surgery, University Hospital Southampton NHS Trust, Southampton, UK
| | - Patricia C Conroy
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Taizo Hibi
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
| | - Mohammad Abu Hilal
- Department of Surgery, Poliambulanza Foundation Hospital, Brescia, Italy
- Department of Surgery, University Hospital Southampton NHS Trust, Southampton, UK
| | - Daniel Hoffman
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Keon Min Park
- Division of Plastic Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Jaeyun Wang
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | | | - Adnan Alseidi
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - International Post-Hepatectomy Liver Failure Study Group
- International Post-Hepatectomy Liver Failure Study Group: Yuta Abe (Department of Surgery, Keio University School of Medicine, Tokyo, Japan); Thomas Armstrong (Department of Surgery, University Hospital Southampton NHS Trust, Southampton, UK); Alessandro Ferrero (Department of General and Oncological Surgery, Umberto I Mauriziano Hospital, Largo Turati, Turin, Italy); Carlos Corvera (Department of Surgery, Division of Surgical Oncology, University of California San Francisco, San Francisco, CA, USA); Koki Hayashi (Department of Surgery, Keio University School of Medicine, Tokyo, Japan); Taisuke Imamura (Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, Sunto-Nagaizumi, Shizuoka, Japan); Minoru Kitago (Department of Surgery, Keio University School of Medicine, Tokyo, Japan); Shoji Kubo (Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan); Masatsugu Ishii (Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan); Federico Mocchegiani (Hepatobiliary and Abdominal Transplantation Surgery, Department of Experimental and Clinical Medicine, Riuniti Hospital, Polytechnic University of Marche, Ancona, Italy); Zenichi Morise (Department of Surgery, Okazaki Medical Center, Fujita Health University School of Medicine, Okazaki, Japan); Kosuke Ogawa (Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan); Yukiyasu Okamura (Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, Sunto-Nagaizumi, Shizuoka, Japan); Shimpei Otsuka (Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, Sunto-Nagaizumi, Shizuoka, Japan); John Primrose (Department of Surgery, University Hospital Southampton NHS Trust, Southampton, UK); Edoardo Rosso (Department of Surgery, Poliambulanza Foundation Hospital, Brescia, Italy; Department of Surgery, Elsan Pôle Santé Sud, Le Mans, France); Fernando Rotellar (HPB and Liver Transplant Unit. Department of General and Digestive Surgery, Clínica Universidad de Navarra, Pamplona, Spain); Nadia Russolillo (Department of General and Oncological Surgery, Umberto I Mauriziano Hospital, Largo Turati, Turin, Italy); Shareef M Syed (Department of Surgery, Division of Abdominal Transplantation), University of California San Francisco, San Francisco, CA, USA); Minoru Tanabe (Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan); Shogo Tanaka (Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan); Fumihiro Terasaki (Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, Sunto-Nagaizumi, Shizuoka, Japan); Marco Vivarelli (Hepatobiliary and Abdominal Transplantation Surgery, Department of Experimental and Clinical Medicine, Riuniti Hospital, Polytechnic University of Marche, Ancona, Italy); Giuseppe Zimmitti (Department of Surgery, Poliambulanza Foundation Hospital, Brescia, Italy)
| |
Collapse
|
3
|
Rammohan A, Rela M, Kumar GV, Scott JX, Shanmugam N, Reddy MS, Ramachandran P. Outcomes for high-risk hepatoblastoma in a resource-challenged setting. BJS Open 2020; 4:630-636. [PMID: 32379933 PMCID: PMC7397353 DOI: 10.1002/bjs5.50297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 04/09/2020] [Indexed: 11/30/2022] Open
Abstract
Background Outcomes of high‐risk hepatoblastoma have been dismal, especially in resource‐challenged countries where access to chemotherapy and paediatric liver transplantation is limited for the underprivileged. This study aimed to assess the results of treatment of high‐risk hepatoblastoma in a tertiary centre, including patients who had non‐transplant surgical procedures in the form of extended resection. Methods A review of patients with high‐risk hepatoblastoma treated between January 2012 and May 2018 was carried out. Perioperative data and long‐term outcomes were analysed. Results Of 52 children with hepatoblastoma, 22 were considered to have high‐risk hepatoblastoma (8 girls and 14 boys). The mean(s.d.) age at diagnosis was 35(20) months. Of these 22 children, five died without surgery. Of the remaining 17 who underwent surgery, six had a resection (4 right and 2 left trisectionectomies) and 11 underwent living‐donor liver transplantation. Median follow‐up was 48 (range 12–90) months. Thirteen of the 17 children were alive at last follow‐up and four developed disseminated disease (3 had undergone liver transplantation and 1 liver resection). The overall survival rate at 1, 3 and 5 years was 77, 64 and 62 per cent for the whole cohort with high‐risk hepatoblastoma. In children who had surgery, 1‐, 3‐ and 5‐year survival rates were 91, 82 and 73 per cent for transplantation and 100, 83 and 83 per cent for resection. There was no difference in survival between the two surgical groups. Conclusion Excellent results in the treatment of high‐risk hepatoblastoma are possible, even in resource‐challenged countries.
Collapse
Affiliation(s)
- A Rammohan
- Institute of Liver Disease and Transplantation, Sree Balaji Medical College Hospital, Bharat Institute of Higher Education and Research, Chennai, India
| | - M Rela
- Ray of Light Foundation, Kanchi Kamakoti Children's Health Institute Laboratory and Diagnostic Services (CHILDS) Trust Hospital, CHILDS Trust Medical Research Foundation, Chennai, India
| | - G V Kumar
- Institute of Liver Disease and Transplantation, Sree Balaji Medical College Hospital, Bharat Institute of Higher Education and Research, Chennai, India
| | - J X Scott
- Institute of Liver Disease and Transplantation, Sree Balaji Medical College Hospital, Bharat Institute of Higher Education and Research, Chennai, India
| | - N Shanmugam
- Institute of Liver Disease and Transplantation, Sree Balaji Medical College Hospital, Bharat Institute of Higher Education and Research, Chennai, India
| | - M S Reddy
- Institute of Liver Disease and Transplantation, Sree Balaji Medical College Hospital, Bharat Institute of Higher Education and Research, Chennai, India
| | - P Ramachandran
- Institute of Liver Disease and Transplantation, Sree Balaji Medical College Hospital, Bharat Institute of Higher Education and Research, Chennai, India.,Ray of Light Foundation, Kanchi Kamakoti Children's Health Institute Laboratory and Diagnostic Services (CHILDS) Trust Hospital, CHILDS Trust Medical Research Foundation, Chennai, India
| |
Collapse
|