Preoperative thrombocytopenia may predict poor surgical outcome after extended hepatectomy

Abstract

Background. It is a novel idea that platelet counts may be associated with postoperative outcome following liver surgery. This may help in planning an extended hepatectomy (EH), which is a surgical procedure with high morbidity and mortality. Aim. The aim of this study was to evaluate the predictive potential of platelet counts on the outcome of EH in patients without portal hypertension, splenomegaly, or cirrhosis. Methods. A series of 213 consecutive patients underwent EH (resection of ≥ five liver segments) between 2001 and 2016. The association of preoperative platelet counts with posthepatectomy liver failure (PHLF), morbidity (based on Clavien-Dindo classification), and 30-day mortality was evaluated using multivariate analysis. Results. PHLF was detected in 26.3% of patients, major complications in 26.8%, and 30-day mortality in 11.3% of patients. Multivariate analysis revealed that the preoperative platelet count is an independent predictor of PHLF (odds ratio [OR] 4.4, 95% confidence interval [CI] 1.3-15.0, p=0.020) and 30-day mortality (OR 4.4, 95% CI 1.1-18.8, p=0.043). Conclusions. Preoperative platelet count is associated with PHLF and mortality following extended liver resection. This association was independent of other related parameters. Prospective studies are needed to evaluate the predictive role and to determine the impact of preoperative correction of platelet count on postoperative outcomes after EH.

Meta-analysis of the prognostic role of perioperative platelet count in posthepatectomy liver failure and mortality

“…The PLT was significantly lower in patients with PHLF in one of these studies; no significant correlation between PLT and PHLF was observed in the other two. Of the remaining 13 studies (5260 patients), seven used a cut‐off PLT of 100/nl and five a cut‐off value of 150/nl. Venkat and colleagues reported outcomes for both PLT cut‐off values.…”

“…Alkozai and colleagues, Reidiger et al . and Ratti and co‐workers reported only patients with liver metastasis, whereas all primary, metastatic and benign tumours were indications for hepatectomy in five studies . PHLF rates ranged from 0 per cent to 43·1 per cent, and mortality rates from 0·5 per cent to 15·6 per cent.…”

“…A further 611 articles were excluded for various reasons, such as irrelevant studies, experimental studies or review articles. After reading the remaining 103 articles, 16 studies were included in the qualitative analysis.…”

“…PHLF was reported in four studies and mortality in seven studies using a PLT cut‐off value of 100/nl. Among the studies using a PLT cut‐off value of 150/nl, mortality was reported in four and PHLF in four studies.…”

“…A total of 817 patients were analysed in the 150/nl cut‐off group. The PHLF rate was 21·3 per cent in patients with a PLT less than 150/nl, whereas PHLF was reported in only 11·8 per cent of patients with a PLT of 150/nl or greater.…”