A scoring system to predict the risk of major complications after laparoscopic liver resection in elderly patients with hepatocellular carcinoma

Lee, Boram; Cho, Jai Young; Han, Ho‐Seong; Yoon, Yoo‐Seok; Lee, Hae Won; Lee, Jun Suh; Kim, Moonhwan; JO, Yeongsoo

doi:10.1007/s00464-022-09303-w

Cited by 4 publications

(3 citation statements)

References 30 publications

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“…In the past reports, it has been reported that GNRI showed good predictive abilities for complications 23,24 and recurrence‐free survival/OS in liver resection, 25 whereas GNRI was an independent prognostic factor for OS in transcatheter arterial chemoembolization 26 and for discontinuation of lenvatinib 27 against HCC. Based on the present results, GNRI might play a great role for predicting prognosis also in Atez/Bev for HCC.…”

Section: Discussionmentioning

confidence: 99%

Geriatric nutritional risk index as an easy‐to‐use assessment tool for nutritional status in hepatocellular carcinoma treated with atezolizumab plus bevacizumab

Hiraoka

Kumada

Tada

et al. 2023

Hepatology Research

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AimThe present study focused on Geriatric Nutritional Risk Index (GNRI), which is based on bodyweight and serum albumin, and known as an easy‐to‐use nutritional assessment tool in clinical settings, to elucidate the prognostic predictive ability of GNRI in patients treated with atezolizumab plus bevacizumab (Atez/Bev) for hepatocellular carcinoma (HCC).MethodsA total of 525 HCC patients treated with Atez/Bev, based on their classification of unsuitable status for curative treatments and/or transarterial catheter chemoembolization, were enrolled (Child–Pugh A:B:C = 484:40:1, Barcelona Clinic Liver Cancer stage 0:A:B:C:D = 7:25:192:283:18). Prognosis was evaluated retrospectively using GNRI.ResultsAtez/Bev was used in 338 of the present cohort as first‐line systemic chemotherapy (64.4%). Median progression‐free survival based on GNRI indicating normal, mild decline, moderate decline, and severe decline was 8.3, 6.7, 5.3, and 2.4 months, respectively, whereas median overall survival was 21.4, 17.0, 11.5. and 7.3 months, respectively (both p < 0.001). The concordance index (c‐index) values of GNRI for predicting prognosis (progression‐free survival/overall survival) were superior to those of Child–Pugh class and albumin‐bilirubin grade (0.574/0.632 vs. 0.527/0.570 vs. 0.565/0.629). As a subanalysis, muscle volume loss was observed in 37.5% of 256 patients with computed tomography data available. Along with GNRI decline, frequency of muscle volume loss became progressively larger (normal vs. mild vs. moderate vs. severe = 17.6% vs. 29.2% vs. 41.2% vs. 57.9%, p < 0.001), and a GNRI value of 97.8 was predictive of its occurrence (AUC 0.715, 95% CI 0.649–0.781; specificity/sensitivity = 0.644/0.688).ConclusionThese findings indicate that GNRI is an effective nutritional prognostic tool for predicting prognosis and muscle volume loss complication in HCC patients treated with Atez/Bev.

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Section: Discussionmentioning

confidence: 99%

Geriatric nutritional risk index as an easy‐to‐use assessment tool for nutritional status in hepatocellular carcinoma treated with atezolizumab plus bevacizumab

Hiraoka

Kumada

Tada

et al. 2023

Hepatology Research

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“…The mechanisms underlying the association between low pretreatment GNRI and poor OS in patients with HCC may be multifactorial. For patients who received laparoscopic or open hepatectomy, malnutrition as evidenced by low pretreatment GNRI has been related to a higher risk of severer perioperative complications [26,38], which may adversely affect the long-term prognosis of these patients. Moreover, for patients who were treated with targeted medications such as lenvatinib, a low pretreatment GNRI was shown to be associated with a higher frequency of discontinuation of lenvatinib due to adverse events [29].…”

Section: Discussionmentioning

confidence: 99%

Geriatric Nutritional Risk Index and the Survival of Patients with Hepatocellular Carcinoma: A Meta-Analysis

Kang

Zhang

et al. 2023

Horm Metab Res

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Malnutrition is a risk factor of adverse clinical outcome in patients with cancer. Recent studies suggest that geriatric nutritional risk index (GNRI) could reflect the nutritional status in patients with various clinical conditions. The aim of the systematic review and meta-analysis was to evaluate the association between GNRI and survival of patients with hepatocellular carcinoma (HCC). Observational studies evaluating the association between pretreatment GNRI and survival of patients with HCC were obtained by search of PubMed, Web of Science, Embase, Wanfang, and CNKI databases. A random-effects model was used to pool the results after incorporating the potential influence of heterogeneity. Seven cohort studies including 2636 patients with HCC contributed to the meta-analysis. Pooled results showed that HCC patients with low pretreatment GNRI were associated with poor overall survival [hazard ratio (HR): 1.77, 95% confidence interval (CI): 1.32 to 2.37, p<0.001; I2=66%) and progression-free survival (HR: 1.62, 95% CI: 1.39 to 1.89, p<0.001; I2=0%) as compared to those with normal GNRI. Sensitivity analyses by excluding one study at a time showed similar results (p all<0.05). Subgroup analyses showed that the association between low pretreatment GNRI and poor survival of patients with HCC was not significantly affected by age of the patients, main treatment, cutoff of GNRI, or the follow-up durations. In conclusion, malnutrition indicated by a low pretreatment GNRI may be a risk factor of poor survival of patients with HCC.

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“…Postoperative liver insufficiency was diagnosed if the peak postoperative TB level was more than 7 mg/dL and/or the ascites present totaled more than 500 mL per day [10]. Postoperative complications were classified using a modified version of the Clavien system, which has been previously described [11]. The incidence of rehospitalization and the length of intensive care unit admission and postoperative hospital stay were investigated.…”

Section: Data Collectionmentioning

confidence: 99%

Clinical Factors Affecting the Rate of Liver Regeneration in Living Donors after Right Hepatectomy

Kim,

Suh,

Lee

et al. 2024

JPM

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Sufficient liver regeneration after a right hepatectomy is important in living donors for preventing postoperative hepatic insufficiency; however, it differs for each living donor so we investigated the clinical factors affecting the rate of liver regeneration after hepatic resection. This retrospective case–control study investigated fifty-four living donors who underwent a right hepatectomy from July 2015 to March 2023. Patients were classified into 2 groups by the remnant/total volume ratio (RTVR): Group A (RTVR < 30%, n = 9) and Group B (RTVR ≥ 30%, n = 45). The peak postoperative level of total bilirubin was more elevated in Group A than in Group B (3.0 ± 1.1 mg/dL vs. 2.3 ± 0.8 mg/dL, p = 0.046); however, no patients had hepatic insufficiency or major complications. The rates of residual liver volume (RLV) growth at Postoperative Week 1 (89.1 ± 26.2% vs. 53.5 ± 23.7%, p < 0.001) were significantly greater in Group A, and its significant predictors were RTVR (β = −0.478, p < 0.001, variance inflation factor (VIF) = 1.188) and intraoperative blood loss (β = 0.247, p = 0.038, VIF = 1.182). In conclusion, as the RLV decreases, compensatory liver regeneration after hepatic resection becomes more prominent, resulting in comparable operative outcomes. Further studies are required to investigate the relationship between hematopoiesis and the rate of liver regeneration.

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A scoring system to predict the risk of major complications after laparoscopic liver resection in elderly patients with hepatocellular carcinoma

Cited by 4 publications

References 30 publications

Geriatric nutritional risk index as an easy‐to‐use assessment tool for nutritional status in hepatocellular carcinoma treated with atezolizumab plus bevacizumab

Geriatric nutritional risk index as an easy‐to‐use assessment tool for nutritional status in hepatocellular carcinoma treated with atezolizumab plus bevacizumab

Geriatric Nutritional Risk Index and the Survival of Patients with Hepatocellular Carcinoma: A Meta-Analysis

Clinical Factors Affecting the Rate of Liver Regeneration in Living Donors after Right Hepatectomy

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