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Predictors of post-hepatectomy liver failure in patients undergoing extensive liver resections for hepatocellular carcinoma
Ann Hepatobiliary Pancreat Surg 2018 Aug;22(3):185-96
Published online August 31, 2018
Copyright © 2018 Ann Hepatobiliary Pancreat Surg.

Ken Min Chin1, John Carson Allen2, Jin Yao Teo1,2, Juinn Huar Kam1,2, Ek Khoon Tan1,2, Yexin Koh1, Brian K. P. Goh1,2, Peng Chung Cheow1,2, Prema Raj1,2, Kah Hoe Pierce Chow1,2,3,Yaw Fui Alexander Chung1,2, London Lucien Ooi1,2, Chung Yip Chan1,2, Ser Yee Lee1,2

1Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, 
2Duke-National University of Singapore (NUS) Medical School, 
3Department of Surgical Oncology, National Cancer Centre Singapore, Singapore  
Received January 3, 2018; Revised June 12, 2018; Accepted June 14, 2018.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Backgrounds/Aims: To determine the prevalence of post-hepatectomy liver failure/insufficiency (PHLF/I) in patients undergoing extensive hepatic resections for hepatocellular carcinoma (HCC) and to assess the predictive value of preoperative factors for post-hepatectomy liver failure or insufficiency (PHLF/I). 
Methods: A retrospective review of patients who underwent liver resections for HCC between 2001 and 2013 was conducted. Preoperative parameters were assessed and analyzed for their predictive value of PHLF/I. Definitions used included the 50-50, International Study Group of Liver Surgery (ISGLS) and Memorial Sloan Kettering Cancer Centre (MSKCC) criteria. 
Results: Among the 848 patients who underwent liver resections for HCC between 2001 and 2013, 157 underwent right hepatectomy (RH) and extended right hepatectomy (ERH). The prevalence of PHLF/I was 7%, 41% and 28% based on the 50-50, ISGLS and MSKCC criteria, respectively. There were no significant differences in PHLF/I between RH and ERH. Model for End-Stage Liver Disease (MELD) score and bilirubin were the strongest independent predictors of PHLF/I based on the 50-50 and ISGLS/MSKCC criteria, respectively. Predictive models were developed for each of the criteria with multiple logistic regression. 
Conclusions: MELD score, bilirubin, alpha-fetoprotein and platelet count showed significant predictive value for PHLF/I (all p<0.05). A composite score based on these factors serves as guideline for physicians to better select patients undergoing extensive resections to minimize PHLF.
Keywords : Liver; Resection; Cirrhosis; Liver failure; Predictors


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