Impact of model for end-stage liver disease (MELD) score on prognosis after hepatectomy for hepatocellular carcinoma on cirrhosis

Abstract

The objective of this study was to predict postoperative liver failure and morbidity after hepatectomy for hepatocellular carcinoma (HCC) with cirrhosis. The model for end-stage liver disease (MELD) score is currently accepted as a disease severity index of cirrhotic patients awaiting liver transplantation; however, its impact on prognosis after resection of HCC on cirrhosis has never been investigated. One hundred fifty-four cirrhotic patients resected in a tertiary care setting for HCC were retrospectively analyzed. For each patient, the MELD score was calculated and related to postoperative liver failure and complications (morbidity). Hospital stay and 1-year survival was also investigated. MELD accuracy in predicting postoperative liver failure and morbidity of cirrhotic patients was assessed using receiver operating characteristic (ROC) analysis. Eleven patients (7.1%) experienced postoperative liver failure leading to death or transplantation. ROC analysis identified cirrhotic patients with a MELD score equal to or above 11 at high risk for postoperative liver failure (area under the curve [AUC] ϭ 0.92, 95% confidence interval [CI] ϭ 0.87-0.96; sensitivity ϭ 82%; specificity ϭ 89%). Forty-six patients (29.9%) developed at least 1 postoperative complication: ROC analysis identified patients with a MELD score equal to or above 9 at major risk for postoperative complications (AUC ϭ 0.85, 95% CI ϭ 0.78-0.89; sensitivity ϭ 87%; specificity ϭ 63%). Cirrhotic patients with MELD score below 9 had no postoperative liver failure and low morbidity (8.1%). In conclusion, the MELD score can accurately predict postoperative liver failure and morbidity of cirrhotic patients referred for resection of HCC and should be used to select the best candidates for hepatectomy. Liver Transpl 12: 966-971, 2006.

Surgery in the Patient with Liver Disease

“…In addition to predicting mortality, the MELD score can predict morbidity after liver resection. In one study (33), the frequency of post-liver resection liver failure was 0%, 3.6%, and 37.5% in patients with MELD scores of less than 9, 9 -10, and greater than 10, respectively. The extent of hepatectomy is also a predictor of mortality, as is a low serum sodium concentration (34).…”

The model for end-stage liver disease (MELD)

“…56 This MELD cutoff of 8 for carrying out hepatic resection for HCC has been confirmed by a study from Italy. 57 The utility of MELD in determining postoperative mortality has also been confirmed in patients undergoing cardiac surgery, 58 as well as in abdominal operations including cholecystectomy, [59][60][61] However, MELD was an inaccurate predictor of mortality in patients without cirrhosis undergoing liver resection. 62 In our experience, MELD, the ASA physical status, and age can be used to determine mortality following surgery independent of the procedure performed.…”

Liver volumetry: Is imaging reliable? Personal experience and review of the literature

“…PHLF is the standardized term to define the post-surgical acquired deterioration of the synthetics, excretory and detoxifying functions of the liver; this syndrome is characterized by an increase of the international normalized ratio values and of serum bilirubin levels from the fifth post-operative day [6] . This syndrome has a reported incidence of 1.2%-32% [7][8][9] . As mentioned above, the posthepatectomy mortality reported in recent years varies between 0% and 5% and the onset of PHLF remains the main cause [10][11][12] .…”