Impact of post-hepatectomy liver failure on morbidity and short- and long-term survival after major hepatectomy

Abstract

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.

Prevention of post-hepatectomy liver failure after major resection of colorectal liver metastases: is hepato-biliary scintigraphy the optimal tool?

“…The authors also found that all complications were significantly more frequently after major hepatectomy. Despite some differences in definitions, our results are similar to those reported in other studies on complex hepatic surgical interventions in patients with CRLM ( 30 - 33 ).…”

“…When we used HBS as the only preoperative assessment, and calculated the FLR-V values retrospectively, we found that 17 patients (21.3%) underwent successful surgery, despite a FLR-V <30%, even after LVD ( Table 3 ). We chose a FLR-V cut-off of 30%, like in other studies on patients with CRLM, to take into account the possible effect on liver function of prolonged chemotherapy prior to surgery ( 33 , 34 ). Patients with FLR-V <30% and HBS results above the cut-off had postoperative outcomes similar to patients with concordant HBS and volumetry.…”

Surgical outcomes of gallbladder cancer: the OMEGA retrospective, multicentre, international cohort study

“…More extensive liver resection, specifically major hepatectomy, was associated with the highest risk of morbidity and mortality in this study, predominantly due to liver insufficiency, consistent with previous data on this procedure for other tumour types. 24 It was not possible to draw any conclusions regarding the benefit of segment IVb/V resections over wedge resections in this study, as the exact extent of resection performed in each of these two procedures in practice may be imprecise. Our findings correlating extent of resection with increased morbidity would suggest that, where appropriate, the least extensive liver resection necessary to achieve clear margins should be performed.…”

Current evidence on posthepatectomy liver failure: comprehensive review

“…Presently, the ISGLS PHLF criteria are the most frequently used in literature to define PHLF. Several aspects of the ISGLS criteria have been discussed, such as the potentially lacking clinical relevance of grade A 10 , 11 and that the criteria do not contain a distinction between primary and secondary liver failure 1 . A major problem of the definitions and predictive models mentioned above is their time point of applicability.…”