Impact of post-hepatectomy liver failure on morbidity and short- and long-term survival after major hepatectomy.
Journal
BJS open
ISSN: 2474-9842
Titre abrégé: BJS Open
Pays: England
ID NLM: 101722685
Informations de publication
Date de publication:
07 07 2022
07 07 2022
Historique:
received:
31
01
2022
revised:
15
06
2022
accepted:
29
06
2022
entrez:
18
7
2022
pubmed:
19
7
2022
medline:
22
7
2022
Statut:
ppublish
Résumé
Post-hepatectomy liver failure (PHLF) is one of the most serious postoperative complications after hepatectomy. The aim of this study was to assess the impact of the International Study Group of Liver Surgery (ISGLS) definition of PHLF on morbidity and short- and long-term survival after major hepatectomy. This was a retrospective review of all patients who underwent major hepatectomy (three or more liver segments) for various liver tumours between 2010 and 2018 at two Swedish tertiary centres for hepatopancreatobiliary surgery. Descriptive statistics, regression models, and survival analyses were used. A total of 799 patients underwent major hepatectomy, of which 218 patients (27 per cent) developed ISGLS-defined PHLF, including 115 patients (14 per cent) with ISGLS grade A, 76 patients (10 per cent) with grade B, and 27 patients (3 per cent) with grade C. The presence of cirrhosis, perihilar cholangiocarcinoma, and gallbladder cancer, right-sided hemihepatectomy and trisectionectomy all significantly increased the risk of clinically relevant PHLF (grades B and C). Clinically relevant PHLF increased the risk of 90-day mortality and was associated with impaired long-term survival. ISGLS grade A had more major postoperative complications compared with no PHLF but failed to be an independent predictor of both 90-day mortality and long-term survival. The impact of PHLF grade B/C on long-term survival was no longer present in patients surviving the first 90 days after surgery. The presently used ISGLS definition for PHLF should be reconsidered regarding mortality as only PHLF grade B/C was associated with a negative impact on short-term survival; however, even ISGLS grade A had clinical implications.
Sections du résumé
BACKGROUND
Post-hepatectomy liver failure (PHLF) is one of the most serious postoperative complications after hepatectomy. The aim of this study was to assess the impact of the International Study Group of Liver Surgery (ISGLS) definition of PHLF on morbidity and short- and long-term survival after major hepatectomy.
METHODS
This was a retrospective review of all patients who underwent major hepatectomy (three or more liver segments) for various liver tumours between 2010 and 2018 at two Swedish tertiary centres for hepatopancreatobiliary surgery. Descriptive statistics, regression models, and survival analyses were used.
RESULTS
A total of 799 patients underwent major hepatectomy, of which 218 patients (27 per cent) developed ISGLS-defined PHLF, including 115 patients (14 per cent) with ISGLS grade A, 76 patients (10 per cent) with grade B, and 27 patients (3 per cent) with grade C. The presence of cirrhosis, perihilar cholangiocarcinoma, and gallbladder cancer, right-sided hemihepatectomy and trisectionectomy all significantly increased the risk of clinically relevant PHLF (grades B and C). Clinically relevant PHLF increased the risk of 90-day mortality and was associated with impaired long-term survival. ISGLS grade A had more major postoperative complications compared with no PHLF but failed to be an independent predictor of both 90-day mortality and long-term survival. The impact of PHLF grade B/C on long-term survival was no longer present in patients surviving the first 90 days after surgery.
CONCLUSIONS
The presently used ISGLS definition for PHLF should be reconsidered regarding mortality as only PHLF grade B/C was associated with a negative impact on short-term survival; however, even ISGLS grade A had clinical implications.
Identifiants
pubmed: 35849062
pii: 6645280
doi: 10.1093/bjsopen/zrac097
pmc: PMC9291378
pii:
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© The Author(s) 2022. Published by Oxford University Press on behalf of BJS Society Ltd.
Références
Surgery. 2011 May;149(5):680-8
pubmed: 21316725
HPB (Oxford). 2011 Aug;13(8):528-35
pubmed: 21762295
Surgery. 2019 May;165(5):918-928
pubmed: 30871811
Clin Colorectal Cancer. 2016 Dec;15(4):e193-e198
pubmed: 27297446
J Gastrointest Surg. 2017 Feb;21(2):238-248
pubmed: 27619809
World J Surg. 2021 Mar;45(3):849-856
pubmed: 33191470
Ann Surg Treat Res. 2020 Feb;98(2):62-71
pubmed: 32051814
Scand J Gastroenterol. 2018 Oct - Nov;53(10-11):1335-1339
pubmed: 30345846
Ann Surg. 2004 Aug;240(2):205-13
pubmed: 15273542
Langenbecks Arch Surg. 2021 Feb;406(1):87-98
pubmed: 32778915
BJS Open. 2021 Sep 6;5(5):
pubmed: 34601569
J Hepatobiliary Pancreat Sci. 2022 Jan;29(1):6-15
pubmed: 34866349
J Gastroenterol Hepatol. 2018 Apr;33(4):958-965
pubmed: 28843035
J Am Coll Surg. 2007 May;204(5):854-62; discussion 862-4
pubmed: 17481498
Scand J Surg. 2019 Jun;108(2):130-136
pubmed: 30196769
HPB (Oxford). 2019 Sep;21(9):1185-1193
pubmed: 30777694
Ann Med Surg (Lond). 2018 Aug 23;34:4-10
pubmed: 30181871
Control Clin Trials. 1996 Aug;17(4):343-6
pubmed: 8889347
HPB (Oxford). 2021 Apr;23(4):551-559
pubmed: 32952033
J Gastrointest Surg. 2014 Apr;18(4):729-36
pubmed: 24297653
BJS Open. 2021 Jan 8;5(1):
pubmed: 33609394
Ann Surg. 2005 Dec;242(6):824-8, discussion 828-9
pubmed: 16327492
Br J Surg. 2011 Jun;98(6):836-44
pubmed: 21456090
Surgery. 2014 Jan;155(1):94-105
pubmed: 24694360
Ann Surg. 2021 Dec 14;:
pubmed: 34913896
Arch Surg. 2010 Nov;145(11):1075-81
pubmed: 21079096
J Surg Oncol. 2020 Sep;122(3):469-479
pubmed: 32424895
HPB (Oxford). 2019 Mar;21(3):361-369
pubmed: 30100391
BJS Open. 2021 Jan 8;5(1):
pubmed: 33609383
J Hepatol. 2018 Jul;69(1):182-236
pubmed: 29628281
Br J Surg. 2007 Nov;94(11):1386-94
pubmed: 17583900
HPB (Oxford). 2017 Aug;19(8):682-687
pubmed: 28465090
J Hepatobiliary Pancreat Sci. 2021 Jan;28(1):26-54
pubmed: 33259690
HPB (Oxford). 2018 May;20(5):462-469
pubmed: 29287736
Ann Oncol. 2016 Aug;27(8):1386-422
pubmed: 27380959
Surgery. 2011 May;149(5):713-24
pubmed: 21236455
Surgery. 2021 Oct;170(4):1024-1030
pubmed: 34020794
BJS Open. 2021 Jul 6;5(4):
pubmed: 34254117
Eur J Surg Oncol. 2021 Feb;47(2):216-224
pubmed: 32943278
HPB (Oxford). 2017 Oct;19(10):850-858
pubmed: 28687148