Description

Andreatos et al evaluated patients undergoing hepatectomy and correlated findings with complications such as post-hepatectomy liver failure (PHLF) and bile leak. These can help to identify a patient who may benefit from more aggressive management. The authors are from the Johns Hopkins University, American College of Surgeons, Northwestern University, Washington University, Temple University and the Ohio State University.


Patient selection: hepatectomy (median age 60 years, 80% with primary or metastatic cancer)

 

Parameters associated with PHLF on multivariate analysis:

(1) male gender

(2) ASA score >= 3

(3) cirrhosis

(4) major hepatectomy

(5) biliary tract reconstruction

(6) perioperative blood transfusion

 

Parameters associated with bile leaj on multivariate analysis:

(1) major hepatectomy

(2) biliary tract reconstruction

(3) perioperative blood transfusion

(4) portal vein embolization (PVE)

(5) operation time > 300 minutes

 

albumin-bilirubin (ALBI) score =

= (0.66 * LOG10(serum total bilirbun in µmol/L)) - (0.085 * (serum albumin in g/L))

 

ALBI

Grade

<= - 2.60

1

-2.59 to -1.39

2

> -1.39

3

 

 

Grade of ALBI

Mortality

PHLF

Bile Leak

1

1%

4%

7.1%

2

2.5%

7.2%

11.5%

3

10%

10%

14%

 


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