Perioperative Risk Assessment for Hepatocellular Carcinoma by Using the MELD Score

Abstract

MELD score seems to predict outcome of cirrhotic patients with HCC after hepatectomy.

Pre-operative Nomogram to Predict Risk of Peri-operative Mortality following Liver Resections for Malignancy

“…17,[24][25][26][27] These staging systems are mainly utilized for predicting outcomes in patients with primary liver malignancies in the background of underlying liver disease and are used to determine the appropriate treatment options. Similarly, the accuracy of MELD score to predict peri-operative/ procedural mortality remains contradictory [28][29][30] and the variables used to calculate the MELD score may not be applicable to the broader population without underlying liver disease.…”

Defining Post Hepatectomy Liver Insufficiency: Where do We stand?

“…73 The other clinical tool is the Model for End-Stage Liver Disease (MELD), which incorporates only three biochemical parameters (creatinine, bilirubin, and INR). 74 Both scoring systems were originally developed to grade chronic liver disease and cirrhosis in liver transplant candidates; however, both are currently also used to screen patients preoperatively for the risk of PHLF as well as to evaluate the perioperative liver function. 73,75,76 Patients at the extreme of the Child-Pugh classification, such as those classified as advanced B or C (i.e., bilirubin> 50 μmol/L, serum albumin<2.8 g/dL, PT INR>2.3, moderate to severe ascites, and absence of hepatic encephalopathy), are not candidates for hepatectomy due to their risk of PHLF.…”

“…77 The role of MELD model as a preoperative predictor of PHLF has similarly been extensively evaluated with mixed results. 74,[77][78][79] Several studies have suggested that MELD can be used in the preoperative setting to risk-stratify patients with regard to postoperative PHLF and death. In one study of 2056 patients, the laboratory values that comprise the MELD score were used to create a risk model in which a biological MELD higher than 10 was associated with a higher risk of PHLF and death.…”

Can the model for end-stage liver disease score replace the indocyanine green clearance test in the selection of right hemihepatectomy in Child-Pugh class A?

“…The MELD score shows a significant correlation with the degree of metabolic liver functional impairment, and an increase in the MELD score is associated with a decrease in residual liver function [14]. Thus, the MELD score has been applied to predict the postoperative mortality risk of patients undergoing hepatic resection in Western countries [15,16]. Patients with a MELD score ≥14 have a significantly increased risk of morbidity and poor outcome postabdominal surgery [15].…”

“…Some studies have reported that a MELD score ≥9 independently predicts mortality after resection of HCC [16,17]. Cucchetti et al [18] showed that cirrhotic patients with a MELD score ≥11 may have a high risk of postoperative liver failure.…”