Risk score to predict biliary leakage after elective liver resection. BJS 2018; 105: 128-139.
Published: 13th November 2017
Authors: K. Mohkam, O. Farges, E. Vibert, O. Soubrane, R. Adam, F.‐R. Pruvot et al.
Biliary leakage remains a major cause of morbidity after liver resection. Previous prognostic studies of posthepatectomy biliary leakage (PHBL) lacked power, population homogeneity, and model validation. The present study aimed to develop a risk score for predicting severe PHBL.
In this multicentre observational study, patients who underwent liver resection without hepaticojejunostomy in one of nine tertiary centres between 2012 and 2015 were randomly assigned to a development or validation cohort in a 2 : 1 ratio. A model predicting severe PHBL (International Study Group of Liver Surgery grade B/C) was developed and further validated.
A total of 2218 procedures were included. PHBL of any severity and severe PHBL occurred in 141 (6·4 per cent) and 92 (4·1 per cent) patients respectively. In the development cohort (1475 patients), multivariable analysis identified blood loss of at least 500 ml, liver remnant ischaemia time 45 min or more, anatomical resection including segment VIII, transection along the right aspect of the left intersectional plane, and associating liver partition and portal vein ligation for staged hepatectomy as predictors of severe PHBL. A risk score (ranging from 0 to 5) was built using the development cohort (area under the receiver operating characteristic curve (AUROC) 0·79, 95 per cent c.i. 0·74 to 0·85) and tested successfully in the validation cohort (AUROC 0·70, 0·60 to 0·80). A score of at least 3 predicted an increase in severe PHBL (19·4
The present risk score reliably predicts severe PHBL. It represents a multi‐institutionally validated prognostic tool that can be used to identify a subset of patients at high risk of severe PHBL after elective hepatectomy.Full text
You may also be interested in
Multicentre observational cohort study of implementation and outcomes of laparoscopic distal pancreatectomy.
Authors: S. Lof, A. L. Moekotte, B. Al‐Sarireh, B. Ammori, S. Aroori, D. Durkin et al.
Authors: M. Tanaka, A. L. Mihaljevic, P. Probst, M. Heckler, U. Klaiber, U. Heger et al.
Multicentre analysis of the learning curve for laparoscopic liver resection of the posterosuperior segments.
Authors: G. Berardi, D. Aghayan, Å. A. Fretland, H. Elberm, F. Cipriani, A. Spagnoli et al.
Validation of a nomogram to predict the risk of cancer in patients with intraductal papillary mucinous neoplasm and main duct dilatation of 10 mm or less.
Authors: W. Jung, T. Park, Y. Kim, H. Park, Y. Han, J. He et al.
Secondary technical resectability of colorectal cancer liver metastases after chemotherapy with or without selective internal radiotherapy in the randomized SIRFLOX trial.
Authors: B. Garlipp, P. Gibbs, G. A. Van Hazel, R. Jeyarajah, R. C. G. Martin, C. J. Bruns et al.
Authors: S. Otsuka, T. Ebata, Y. Yokoyama, T. Igami, T. Mizuno, J. Yamaguchi et al.
Meta‐analysis of the association between primary tumour location and prognosis after surgical resection of colorectal liver metastases.
Authors: X.‐Y. Wang, R. Zhang, Z. Wang, Y. Geng, J. Lin, K. Ma et al.
Quality of life from a randomized trial of laparoscopic or open liver resection for colorectal liver metastases. BJS 2019; 106: 1372-1380.
Authors: Å. A. Fretland, V. J. Dagenborg, G. M. Waaler Bjørnelv, D. L. Aghayan, A. M. Kazaryan, L. Barkhatov et al.
Safety and efficacy of transarterial embolization of hepatocellular adenomas. BJS 2019; 106: 1362-1371.
Authors: B. V. van Rosmalen, A. J. Klompenhouwer, J. Jaap de Graeff, M. P. D. Haring, V. E. de Meijer, L. Rifai et al.
Authors: A. Pulvirenti, A. Pea, N. Rezaee, C. Gasparini, G. Malleo, M. J. Weiss et al.
Impact of postoperative infective complications on long‐term survival after liver resection for hepatocellular carcinoma.
Authors: T. Yang, K. Liu, C.‐F. Liu, Q. Zhong, J. Zhang, J.‐J. Yu et al.
Meta‐analysis of randomized clinical trials of early versus delayed cholecystectomy for mild gallstone pancreatitis.
Authors: N. Moody, A. Adiamah, F. Yanni, D. Gomez