Safe Hepatectomy Selection Criteria for Hepatocellular Carcinoma Patients: A Validation of 336 Consecutive Hepatectomies. The BILCHE Score
- 518 Downloads
Selection criteria for hepatectomy for hepatocellular carcinoma (HCC) are object of debate. We presented our criteria for safe hepatectomy for HCC, and we compared the results with those obtainable using the most common scores for HCC.
All patients submitted to hepatectomy for HCC based on the same criteria were reviewed from our prospectively maintained database. Such criteria included bilirubin (BIL), cholinesterases (CHE), ascites, esophageal varices, and residual liver volume.
A total of 336 patients were analyzed. One hundred fifteen patients (33 %) had thoracoabdominal approach, but only 39 (12 %) had major or extended resections. The median tumor number was 1 (range 1–33), while the median tumor size was 3.6 cm (range 1.1–28). Of those, 94 (29 %) had postoperative complications, of which 6 % were graded as major (Dindo III–IV). The 90-days mortality was 2 %. The MELD, APRI, and CPT scores were not found to be statistically significant for complications, while combining BIL and CHE we defined four classes of risk. The association of BIL >1 mg/dl (>17.1 µmol/l) and CHE ≤5,900 U/l was the best to detect complications (OR = 4.45; P = 0.007).
This study shows that our selection criteria that count mainly on two commonly available, and inexpensive parameters, BIL and CHE, lead to identify patients potentially at risk of postoperative complications after hepatic resection for HCC. Registration number: NCT02056041 (http://www.clinicaltrials.gov).
KeywordsHepatic Resection Transjugular Intrahepatic Portosystemic Shunt Esophageal Varix Portal Vein Embolization Postoperative Liver Failure
- 4.Torzilli G, Belghiti J, Kokudo N et al (2013) A snapshot of the effective indications and results of surgery for hepatocellular carcinoma in tertiary referral centers: is it adherent to the EASL/AASLD recommendations?: an observational study of the HCC East-West study group. Ann Surg 257(5):929–937PubMedCrossRefGoogle Scholar
- 6.Shindoh J, CW DT, Vauthey JN (2012) Portal vein embolization for hepatocellular carcinoma. Liver Cancer 1(3–4):159–167Google Scholar
- 14.Belghiti J, Clavien P, Gadzijev E et al (2000) The Brisbane 2000 terminology of liver anatomy and resections. HPB (Oxford) 2(3):333–339Google Scholar
- 16.Imamura H, Seyama Y, Kokudo N et al (2003) One thousand fifty-six hepatectomies without mortality in 8 years. Arch Surg 138(11):1198–1206; discussion 1206Google Scholar
- 19.(1980) The general rules for recording endoscopic findings on esophageal varices. Jpn J Surg 10(1):84-87Google Scholar
- 20.Torzilli G (2014) Ultrasound-Guided Liver Surgery: An Atlas, Springer-Verlag, MilanGoogle Scholar
- 26.Teh SH, Christein J, Donohue J et al (2005) Hepatic resection of hepatocellular carcinoma in patients with cirrhosis: model of end-stage liver disease (MELD) score predicts perioperative mortality. J Gastrointest Surg 9(9):1207–1215; discussion 1215Google Scholar