Association of preoperative albumin–bilirubin with surgical textbook outcomes following laparoscopic hepatectomy for hepatocellular carcinoma

Abstract

Background and aimsRecently, the effectiveness of “textbook outcomes (TO)” in the evaluation of surgical quality has been recognized by more and more scholars. This study tended to examine the association between preoperative albumin–bilirubin (ALBI) grades and the incidence of achieving or not achieving TO (non-TO) in patients with hepatocellular carcinoma (HCC) undergoing laparoscopic hepatectomy.MethodsThe patients were stratified into two groups: ALBI grade 1 (ALBI ≤ -2.60) and ALBI grade 2/3 (ALBI > -2.60). The characteristics of patients and the incidence of non-TO were compared. Multivariate analyses were performed to determine whether ALBI grade was independently associated with TO.ResultsIn total, 378 patients were enrolled, including 194 patients (51.3%) in the ALBI grade 1 group and 184 patients (48.7%) in the ALBI grade 2/3 group. In the whole cohort, 198 patients (52.4%) did not achieve TO, and the incidence of non-TO in the ALBI grade 2/3 group was obviously higher than that in the ALBI grade 1 group (n = 112, 60.9% vs. n = 86, 44.3%, P = 0.001). The multivariate analyses showed that ALBI grade 2/3 was an independent risk factor for non-TO (OR: 1.95, 95%CI: 1.30–2.94, P = 0.023).ConclusionsMore than half (52.4%) of the patients with hepatocellular carcinoma did not achieve TO after laparoscopic hepatectomy, and preoperative ALBI grade 2/3 was significantly associated with non-TO. Improving the liver function reserve of patients before operation, thereby reducing the ALBI grade, may increase the probability for patients to reach TO and enable patients to benefit more from surgery.

The pre- and postoperative nomograms to predict the textbook outcomes of patients who underwent hepatectomy for hepatocellular carcinoma

“…Similarly, obesity, BMI > 28 kg/m 2 , also had a negative impact on TO in the present study. High ALBI and portal hypertension, indicators of poor liver function, were proved in previous studies (14,17,25). Insufficient liver reserve is closely related to postoperative complications, including liver failure and massive ascites.…”

“…Postoperative morbidities include liver failure, bile leakage or other biliary complications, hemorrhage, infection from a variety of causes, and cardiovascular, brain, pulmonary, renal, and other complications. According to the criterion for the prolonged length of hospital stay after surgery (17), we defined 10 days as the cutoff value. The negative result of both microscopic and macroscopic observations of resection margin was defined as R0 resection (22).…”

“…Compared with open liver resection, laparoscopic liver resection (LLR) tends to reach TO, which reflects the advantages of minimally invasive surgery (17).…”

The Association of Albumin-Bilirubin (ALBI) Grade with Mortality Risk in Trauma Patients with Liver Injuries

“…Patients who died had a significantly lower ALBI score than those who survived (2.8±0.4 vs 3.4±0.7, p < 0.001). Patients who died had a significantly lower GCS score (median [Q 1 -Q 3 ]; 8 [3][4][5][6][7][8][9][10][11][12][13] vs 15 [14][15], p < 0.001) but higher ISS (median [Q 1 -Q 3 ]; 33 [24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40] vs 20 [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29], p < 0.001) than the surviving patients.…”

“…[15][16][17][18][19][20] It also functions as a crucial biomarker for the development of liver disease, reflecting the potential for hepatic failure and mortality from liver-related causes. [21][22][23][24][25][26][27] Patients with cholangiocarcinoma, 28 intrahepatic cholangiocarcinoma, 29 pancreatic cancer with liver metastases, 30 colorectal cancer with liver metastases, 31 and primary biliary cholangitis 32 can all benefit from knowing their ALBI grade as a prognostic indicator. Additionally, other non-hepatological disorders, including aortic dissection, 33 heart failure, 34,35 acute pancreatitis, 36 lung cancer, 24,37,38 esophageal cancer, 39 gastric cancer, 40 lung cancer, 41 and medulloblastoma, 42 have shown a high correlation between ALBI and death.…”