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Journal of Gastrointestinal Surgery

, Volume 18, Issue 4, pp 729–736 | Cite as

Assessment of ISGLS Definition of Posthepatectomy Liver Failure and Its Effect on Outcome in Patients with Hepatocellular Carcinoma

  • Kenji Fukushima
  • Takumi Fukumoto
  • Kaori Kuramitsu
  • Masahiro Kido
  • Atsushi Takebe
  • Motofumi Tanaka
  • Tomoo Itoh
  • Yonson Ku
Original Article

Abstract

Background

Posthepatectomy liver failure (PHLF) is a major complication after hepatectomy. As there was no standardized definition, the International Study Group of Liver Surgery (ISGLS) defined PHLF as increased international normalized ratio and hyperbilirubinemia on or after postoperative day 5 in 2010. We evaluated the impact of the ISGLS definition of PHLF on hepatocellular carcinoma (HCC) patients.

Methods

We retrospectively analyzed 210 consecutive HCC patients who underwent curative hepatectomy at our facility from 2005 to 2010. The median follow-up period after hepatectomy was 35.2 months.

Results

Thirty-nine (18.6 %) patients fulfilled the ISGLS definition of PHLF. Overall survival (OS) rates at 1, 3, and 5 years in patients with/without PHLF were 69.1/93.5, 45.1/72.5, and 45.1/57.8 %, respectively (P = 0.002). Recurrence-free survival (RFS) rates at 1, 3, and 5 years in patients with/without PHLF were 40.9/65.9, 15.7/38.3, and 15.7/20.3 %, respectively (P = 0.003). Multivariate analysis revealed that PHLF was significantly associated with both OS (P = 0.047) and RFS (P = 0.019). Extent of resection (P < 0.001), intraoperative blood loss (P = 0.002), and fibrosis stage (P = 0.040) were identified as independent risk factors for developing PHLF.

Conclusion

The ISGLS definition of PHLF was associated with OS and RFS in HCC patients, and long-term survival will be improved by reducing the incidence of PHLF.

Keywords

International Study Group of Liver Surgery Posthepatecomy liver failure Hepatocellular carcinoma Hepatectomy Survival 

Notes

Disclosures

All authors listed on this manuscript have no financial disclosure.

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Copyright information

© The Society for Surgery of the Alimentary Tract 2013

Authors and Affiliations

  • Kenji Fukushima
    • 1
  • Takumi Fukumoto
    • 1
  • Kaori Kuramitsu
    • 1
  • Masahiro Kido
    • 1
  • Atsushi Takebe
    • 1
  • Motofumi Tanaka
    • 1
  • Tomoo Itoh
    • 2
  • Yonson Ku
    • 1
  1. 1.Division of Hepato-Biliary-Pancreatic Surgery, Department of SurgeryKobe University Graduate School of MedicineKobeJapan
  2. 2.Division of Diagnostic Pathology, Department of PathologyKobe University Graduate School of MedicineKobeJapan

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