Assessment of ISGLS Definition of Posthepatectomy Liver Failure and Its Effect on Outcome in Patients with Hepatocellular Carcinoma

Fukui, Kenji; Fukumoto, Takumi; Kuramitsu, Kaori; Kido, Masahiro; Takebe, Atsushi; Tanaka, Motofumi; Itoh, Tomoo; Ku, Yonson

doi:10.1007/s11605-013-2423-y

Cited by 88 publications

(74 citation statements)

References 26 publications

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“…Liver surgery has led to impressive reductions in mortality and morbidity over the last decade, and is the treatment of choice for a range of primary and secondary liver diseases [1,2,3]. On the other hand, as hepatectomy for hepatocellular carcinoma is often undergone by patients with insufficient hepatic reserve for the future liver remnant, posthepatectomy liver failure is a matter of alarming concern [4].…”

Section: Introductionmentioning

confidence: 99%

Administration of Antithrombin III Attenuates Posthepatectomy Liver Failure in Hepatocellular Carcinoma

et al. 2015

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Background/Aims: Coagulopathy can cause disseminated intravascular coagulation and posthepatectomy liver failure. Posthepatectomy liver failure predicts a poor prognosis after hepatectomy for hepatocellular carcinoma. Although antithrombin III reduces hypercoagulation, the impact of postoperative antithrombin III administration remains unknown. The aim of this study was to determine whether postoperative antithrombin III administration protects against the development of coagulation disorders. Methods: Data from 164 patients who received antithrombin III and 169 who did following curative hepatectomy for hepatocellular carcinoma were retrospectively collected and analyzed. To overcome bias due to different distributions of covariates for the two groups, a one-to-one match was created using propensity score analysis. After matching, patient outcomes were analyzed. Results: A multivariate analysis of the whole group revealed that antithrombin III activity of <50% on postoperative day 1 was an independent risk factor for posthepatectomy liver failure. After one-to-one matching, the rate of posthepatectomy liver failure was significantly lower in the AT-III-treated group than in the non-AT-III-treated group (16.3% (7/43) vs. 44.2% (19/43), p < 0.01). Conclusions: Antithrombin III may attenuate posthepatectomy liver failure in hepatocellular carcinoma, possibly by suppressing coagulopathy.

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Section: Introductionmentioning

confidence: 99%

Administration of Antithrombin III Attenuates Posthepatectomy Liver Failure in Hepatocellular Carcinoma

et al. 2015

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“…Fukushima et al [5] reported major hepatectomy, intraoperative blood loss (>1,000 mL) and stage 3 fibrosis as independent risk factors for PHLF, according to the ISGLS definition [5]. Both the Iguchi and Fukushima groups reported that PHLF was associated with recurrence and survival after resection.…”

Section: Discussionmentioning

confidence: 99%

“…Although various treatment strategies, such as liver resection, local ablation, transcatheter arterial chemoembolization and liver transplantation are available for HCC, liver resection is widely performed as the first-line option because of its low morbidity and mortality rates [2-4]. However, the morbidity rates after hepatectomy remain high [5-7]. …”

Section: Introductionmentioning

confidence: 99%

“…Major liver resection is frequently contraindicated in many patients with HCC because of the increased risk of PHLF [9-11]. Some studies have shown that PHLF was associated with postoperative HCC recurrence and overall survival [5-12]. Previously, the definition of PHLF varied among studies and institutions; however, the term was recently defined by the International Study Group of Liver Surgery (ISGLS) as an increase in the international normalized ratio (INR) of prothrombin time and concomitant hyperbilirubinemia (according to the normal limits of the local laboratory) on or after postoperative day 5 [13].…”

Section: Introductionmentioning

confidence: 99%

“…Some groups have investigated the independent risk factors for PHLF using the classification criteria by ISGLS. For example, Fukushima et al [5] reported extent of resection, intraoperative blood loss and fibrosis stage as independent risk factors for the development of PHLF; whereas Iguchi et al [12] showed significant differences in blood loss and duration of surgery between grade A and grade B/C patients.…”

Section: Introductionmentioning

confidence: 99%

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Impaired Value of 99m Tc-GSA Scintigraphy as an Independent Risk Factor for Posthepatectomy Liver Failure in Patients with Hepatocellular Carcinoma

et al. 2018

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Background: Posthepatectomy liver failure (PHLF) was recently defined with the corresponding recommendations as follows: grade A, no change in clinical management; grade B, clinical management with noninvasive treatment; and grade C, clinical management with invasive treatment. In this study, we identified the risk factors for grade B and C PHLF in patients with hepatocellular carcinoma (HCC). Methods: Of 339 HCC patients who underwent curative hepatic resection, 218 were included for analysis. The LHL15 index (uptake ratio of the liver to that of the liver and heart at 15 min) was measured by 99m Tc-GSA (99m technetium-labelled galactosyl human serum albumin); remnant LHL15 was calculated as LHL15 × [1 − (resected liver weight − tumor volume)/whole liver volume without tumor]. Results: A total of 163 patients were classified as having no PHLF, whereas 17, 37, and 1 patient had PHLF grade A, B, and C, respectively. There were significant differences in indocyanine green R15, serum albumin, prothrombin time, Child-Pugh classification, LHL15 and remnant LHL15 between patients with grades B/C PHLF and patients with grade A or no PHLF. Only remnant LHL15 was identified as an independent risk factor for grades B/C PHLF (p = 0.023), with a cut-off value of 0.755. Conclusions: Remnant LHL15 was an independent risk factor for grades B/C PHLF. Patients with impaired remnant LHL15 value of <0.755 should be carefully monitored for PHLF.

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Current status of preoperative risk assessment for posthepatectomy liver failure in patients with hepatocellular carcinoma

Nishio

Taura

Koyama

et al. 2023

Annals of Gastroent Surgery

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Liver resection is an effective therapeutic option for patients with hepatocellular carcinoma. However, posthepatectomy liver failure (PHLF) remains a major cause of hepatectomy‐related mortality, and the accurate prediction of PHLF based on preoperative assessment of liver functional reserve is a critical issue. The definition of PHLF proposed by the International Study Group for Liver Surgery has gained acceptance as a standard grading criterion. Liver function can be estimated using a variety of parameters, including routine blood biochemical examinations, clinical scoring systems, dynamic liver function tests, liver stiffness and fibrosis markers, and imaging studies. The Child–Pugh score and model for end‐stage liver disease scores are conventionally used for estimating liver decompensation, although the alternatively developed albumin‐bilirubin score shows superior performance for predicting hepatic dysfunction. Indocyanine green clearance, a dynamic liver function test mostly used in Japan and other Asian countries, serves as a quantitative estimation of liver function reserve and helps determine indications for surgical procedures according to the estimated risk of PHLF. In an attempt to improve predictive accuracy, specific evaluation of liver fibrosis and portal hypertension has gained popularity, including liver stiffness measurements using ultrasonography or magnetic resonance elastography, as well as noninvasive fibrosis markers. Imaging modalities, including Tc‐99m‐labeled galactosyl serum albumin scintigraphy and gadolinium‐enhanced magnetic resonance imaging, are used for preoperative evaluation in combination with liver volume. This review aims to provide an overview of the usefulness of current options for the preoperative assessment of liver function in predicting PHLF.

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Assessment of ISGLS Definition of Posthepatectomy Liver Failure and Its Effect on Outcome in Patients with Hepatocellular Carcinoma

Abstract: The ISGLS definition of PHLF was associated with OS and RFS in HCC patients, and long-term survival will be improved by reducing the incidence of PHLF.

Cited by 88 publications

References 26 publications

Administration of Antithrombin III Attenuates Posthepatectomy Liver Failure in Hepatocellular Carcinoma

Administration of Antithrombin III Attenuates Posthepatectomy Liver Failure in Hepatocellular Carcinoma

Impaired Value of 99m Tc-GSA Scintigraphy as an Independent Risk Factor for Posthepatectomy Liver Failure in Patients with Hepatocellular Carcinoma

Current status of preoperative risk assessment for posthepatectomy liver failure in patients with hepatocellular carcinoma

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