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Potential role of cholinesterases to predict short-term outcome after hepatic resection for hepatocellular carcinoma

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Abstract

Estimation of functional liver reserve in patients with hepatocellular carcinoma (HCC) is of paramount importance to properly select candidates for surgical resection. Together with the value of bilirubin, the presence/absence of ascites and esophageal varices, and the rate of residual liver volume, which are our current parameters to measure functional liver reserve, we sought to investigate the value of preoperative cholinesterases (CHE) in predicting postoperative outcome after hepatic resection for HCC. We reviewed the records of 279 consecutive patients who underwent hepatic resection for HCC in our Unit between 2001 and 2011. The value of preoperative CHE was analyzed against the occurrence of postoperative events. Receiver–operator characteristic curve analysis was used to identify cut-off values of CHE that predicted adverse outcomes. Univariate and multivariate analyses on clinically relevant variables, which included the MELD score among others, were performed. P < 0.05 was considered statistically significant. Eighty (29 %) of 279 patients had complications, of which 60 (21.5 %) were liver-related. Major morbidity occurred in 16 (6 %) patients. The 30-day postoperative mortality was 1 %. A value of CHE ≤ 5,900 UI/L had a sensitivity of 73 % and a specificity of 67 % in predicting liver-related postoperative complications (P = 0.001). The multivariate analysis revealed that only blood transfusion, major resections, and a value of CHE ≤ 5,900 UI/L independently predicted the risk of morbidity. The results indicated that CHE contributed important information in predicting postoperative outcome after hepatic resection for HCC. Thus, it should be included in the selection process of candidates to surgery for such disease.

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The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Liver Surgery Unit, Department of General Surgery, University of Milan School of Medicine, Humanitas Cancer Center, IRCCS Istituto Clinico Humanitas, Via Manzoni 56, 20089, Rozzano, Milan, Italy

    Matteo Donadon, Matteo Cimino, Fabio Procopio, Marco Montorsi & Guido Torzilli

  2. Biostatistics Unit, IRCCS Istituto Clinico Humanitas, Rozzano, Milan, Italy

    Emanuela Morenghi

Authors
  1. Matteo Donadon
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  2. Matteo Cimino
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  3. Fabio Procopio
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  4. Emanuela Morenghi
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  5. Marco Montorsi
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  6. Guido Torzilli
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Correspondence to Guido Torzilli.

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Donadon, M., Cimino, M., Procopio, F. et al. Potential role of cholinesterases to predict short-term outcome after hepatic resection for hepatocellular carcinoma. Updates Surg 65, 11–18 (2013). https://doi.org/10.1007/s13304-012-0174-z

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  • DOI: https://doi.org/10.1007/s13304-012-0174-z

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