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Preoperative predictors of liver decompensation after mini-invasive liver resection

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Abstract

Background

Post-hepatectomy liver failure (PHLF) represents the most frequent complication after liver surgery, and the most common cause of morbidity and mortality. Aim of the study is to identify the predictors of PHLF after mini-invasive liver surgery in cirrhosis and chronic liver disease, and to develop a model for risk prediction.

Methods

The present study is a multicentric prospective cohort study on 490 consecutive patients who underwent mini-invasive liver resection from the Italian Registry of Mini-invasive Liver Surgery (I go MILS). Retrospective additional biochemical and clinical data were collected.

Results

On 490 patients (26.5% females), PHLF occurred in 89 patients (18.2%). The only independent predictors of PHLF were Albumin-Bilirubin (ALBI) score (OR 3.213; 95% CI 1.661–6.215; p < .0.0001) and presence of ascites (OR 3.320; 95% CI 1.468–7.508; p = 0.004). Classification and regression tree (CART) modeling led to the identification of three risk groups: PHLF occurred in 23/217 patients with ALBI grade 1 (10.6%, low risk group), in 54/254 patients with ALBI score 2 or 3 and absence of ascites (21.3%, intermediate risk group) and in 12/19 patients with ALBI score 2 or 3 and evidence of ascites (63.2%, high risk group), p < 0.0001. The three groups showed a corresponding increase in postoperative complications (20.0%, 27.5% and 66.7%), Comprehensive Complication Index (5.1 ± 11.1, 6.0 ± 10.9 and 18.8 ± 18.9) and hospital stay (6.0 ± 4.0, 6.0 ± 6.0 and 8.0 ± 5.0 days).

Conclusion

The risk of PHLF can be stratified by determining two easily available preoperative factors: ALBI and ascites. This model of risk prediction offers an objective instrument for a correct clinical decision-making.

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Abbreviations

PHLF:

Post-hepatectomy liver failure

MILS:

Mini-invasive liver surgery

HCC:

Hepatocellular carcinoma

CCC:

Mass-forming cholangiocarcinoma

ALBI:

Albumin-Bilirubin score

LR:

Liver resection

BMI:

Body Mass Index

CART:

Classification and regression tree analysis

ALPPS:

Associating liver partitioning and portal vein ligation for staged hepatectomy

ISGLS:

International Study Group of Liver Surgery

PH:

Portal hypertension

MELD:

Model for end-stage liver disease

DCC:

Dindo–Clavien classification

CCI:

Comprehensive Complication Index

IQR:

Interquartile range

AUC:

Area under curve

MCAR:

Missing completely at random

CHAID:

Chi-square automatic interaction detector

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Acknowledgements

The authors thank The Italian Group of MILS (I Go MILS) registry and all collaborators who equally contributed to this work.

All Collaborators of the I Go MILS Group listed below are coworkers of the study and contributed to acquisition of data, article review for intellectual content and final approval of the version to be published:

Adelmo Antonucci (Policlinico di Monza, Monza, Italy, e-mail: adelmo.antonucci@policlinicodimonza.it), Francesco Ardito (A. Gemelli, IRCCS, Catholic University of the Sacred Heart, Rome, Italy, e-mail: francesco.ardito@unicatt.it), Carlo Battiston (Fondazione IRCCS Istituto Nazionale Tumori di Milano, Milan, Italy, e-mail: carlo.battiston@istitutotumori.mi.it), Giulio Belli (SM Loreto Nuovo Hospital, Naples, Italy, e-mail: giubelli@unina.it), Stefano Berti (Ospedale Civile S. Andrea, La Spezia, Italy, e-mail: stefano.berti@asl5.liguria.it), Ugo Boggi (AOU Pisana, Pisa, Italy, e-mail: u.boggi@med.unipi.it), Alberto Brolese (S. Chiara Hospital, Trento, Italy, e-mail: alberto.brolese@apss.tn.it), Fulvio Calise (Pinetagrande hospital, Castel Volturno, Italy, e-mail: fulvio.calise@aocardarelli.it), Graziano Ceccarelli, (San Donato Hospital, Arezzo, Italy, e-mail: graziano.ceccarelli@usl8.toscana.it), Michele Colledan (AO Papa Giovanni XXIII, Bergamo, Italy, e-mail: mcolledan@asst-pg23.it), Andrea Coratti (AOU Careggi, Florence, Italy, e-mail: corattia@aou-careggi.toscana.it), Stefano Di Sandro (ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy, e-mail: stefano.disandro@ospedaleniguarda.it), Ludovica Ferrara (University of Parma, Parma, Italy), Antonio Floridi (AO Ospedale Maggiore, Crema, Italy), Antonio Frena (Central Hospital, Bolzano, Italy, e-mail: antonio.frena@asbz.it), Antonio Giuliani, (AO R. N. Cardarelli, Naples, Italy), Gian Luca Grazi (Istituto Nazionale Tumori Regina Elena, Rome, Italy, e-mail: glgrazi@chirurgiadelfegato.it), Enrico Gringeri (University of Padua, Padova, Italy, e-mail: enrico.gringeri@unipd.it), Guido Griseri (San Paolo Hospital, Savona, Italy, e-mail: g.griseri@asl2.liguria.it), Salvatore Gruttadauria (Mediterranean Institute for Transplantation and Specialization Therapies IRCCS-ISMETT, Palermo, Italy, e-mail: sgruttadauria@ismett.edu), Silvio Guerriero (San Martino Hospital, Belluno, Italy, e-mail: silvio.guerriero@ulss.belluno.it), Elio Jovine (Ospedale Maggiore, Bologna, Italy, e-mail: elio.jovine@ausl.bologna.it), Giovanni Battista Levi Sandri (S. Camillo Hospital, Rome, Italy, e-mail: gblevisandri@gmail.com), Paolo Magistri (University of Modena and Reggio Emilia, Italy, e-mail: paolo.magistri@unimore.it), Pietro Maida (Villa Betania Hospital, Napoli, Italy), Pietro Mezzatesta (Casa di Cura La Maddalena, Palermo, Italy, e-mail: mezzatesta@lamaddalenanet.it), Giuseppe Navarra (AOU Policlinico G. Martino, Messina, Italy, e-mail: giuseppe.navarra@polime.it), Amilcare Parisi (AO Santa Maria di Terni, Terni, Italy, e-mail: a.parisi@ospterni.it), Antonio Pinna (Digestive Disease Institute at Cleveland Clinic Abu Dhabi), Francesca Ratti, (IRCCS San Raffaele Hospital, Milan, Italy, e-mail: ratti.francesca@hsr.it), Paolo Reggiani, (IRCCS Ospedale Maggiore Policlinico di Milano, Milan, Italy, e-mail: paolo.reggiani@policlinico.mi.it), Raffaele Romito (Ospedale Maggiore Novara, Italy, e-mail: raffele.romito@maggioreosp.novara.it), Andrea Ruzzenente (University of Verona, Italy, e-mail: andrea.ruzzenente@univr.it), Nadia Russolillo (Mauriziano Umberto I Hospital, Torino, Italy, e-mail: nadia.russolillo@libero.it), Roberto Santambrogio (AO San Paolo, Milan, Italy, e-mail: roberto.santambrogio@asst-santipaolocarlo.it), Giovanni Sgroi (AO Treviglio-Caravaggio, Treviglio, Italy, e-mail: giovanni_sgroi@asst-bgovest.it), Abdallah Slim (AO Desio e Vimercate, Vimercate, Italy, e-mail: abdallah.slim@aovimercate.org), Guido Torzilli (Istituto Clinico Humanitas, Rozzano, Italy, e-mail: guido.torzilli@hunimed.eu), Leonardo Vincenti (AOU Consorziale Policlinico, Bari, Italy), Fausto Zamboni (Brotzu Hospital, Cagliari, Italy, e-mail: faustozamboni@yahoo.it).

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Authors and Affiliations

  1. Department of Gastrointestinal Surgery and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori Di Milano, Via Venezian 1, 20133, Milan, Italy

    Carlo Sposito, Michela Monteleone & Vincenzo Mazzaferro

  2. Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy

    Carlo Sposito & Vincenzo Mazzaferro

  3. Hepatobiliary Surgery, IRCCS San Raffaele Hospital, Milan, Italy

    Luca Aldrighetti

  4. Hepatobiliary Surgery and Liver Transplantation Unit, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padua, Italy

    Umberto Cillo

  5. Department of Medicine and Surgery, University of Parma, Parma, Italy

    Raffaele Dalla Valle

  6. Department of Hepatobiliary Surgery, G.B. Rossi Hospital, University of Verona, Verona, Italy

    Alfredo Guglielmi

  7. Division of General Surgery and Liver Transplantation, S. Camillo Hospital, Rome, Italy

    Giuseppe Maria Ettorre

  8. Department of HPB and Digestive Surgery, Ospedale Mauriziano Umberto I, Turin, Italy

    Alessandro Ferrero

  9. Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy

    Fabrizio Di Benedetto

  10. Liver Transplant Unit, Ospedale Maggiore Policlinico, Milan, Italy

    Giorgio Ettore Rossi

  11. Surgical and Transplant Department, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy

    Luciano De Carlis

  12. School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy

    Luciano De Carlis

  13. Hepatobiliary Surgery Unit, A. Gemelli Hospital, Università Cattolica del Sacro Cuore, Rome, Italy

    Felice Giuliante

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  1. Carlo Sposito
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  2. Michela Monteleone
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  13. Vincenzo Mazzaferro
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Corresponding author

Correspondence to Vincenzo Mazzaferro.

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Carlo Sposito, Michela Monteleone, Luca Aldrighetti, Umberto Cillo, Raffaele Dalla Valle, Alfredo Guglielmi, Giuseppe Maria Ettorre, Alessandro Ferrero, Fabrizio Di Benedetto, Giorgio Ettore Rossi, Luciano De Carlis, Felice Giuliante, and Vincenzo Mazzaferro have no conflicts of interest or financial ties to disclose.

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Sposito, C., Monteleone, M., Aldrighetti, L. et al. Preoperative predictors of liver decompensation after mini-invasive liver resection. Surg Endosc 35, 718–727 (2021). https://doi.org/10.1007/s00464-020-07438-2

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