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Michael I Dangelica - One of the best experts on this subject based on the ideXlab platform.
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postoperative Liver Failure risk score identifying patients with resectable perihilar cholangiocarcinoma who can benefit from portal vein embolization
Journal of The American College of Surgeons, 2017Co-Authors: Pim B Olthof, Ronald P Dematteo, Jimme K Wiggers, Bas Groot Koerkamp, Robert J S Coelen, Peter J Allen, Marc G Besselink, Olivier R Busch, Michael I Dangelica, Peter T KinghamAbstract:Background Major Liver resection for perihilar cholangiocarcinoma (PHC) is associated with a 22% to 33% postoperative Liver Failure incidence. The aim of this study was analyze the predictive value of future Liver remnant (FLR) volume for postoperative Liver Failure after resection for PHC and to develop a risk score to improve patient selection for portal vein embolization. Study Design A consecutive series of 217 patients underwent major Liver resection for PHC between 1997 and 2014 at 2 Western centers; FLR volumes were calculated with CT volumetry; other variables included jaundice at presentation, immediate preoperative bilirubin, and preoperative cholangitis. The FLR volume was categorized as 45%. A risk score for postoperative Liver Failure (grade B/C according to the International Study Group of Liver Surgery criteria) was developed using multivariable logistic regression with 5 predefined variables. Results Postoperative Liver Failure incidence was 24% and Liver Failure-related mortality was 12%. Risk factors for Liver Failure were FLR volume 50 μmol/L (>2.9 mg/dL) (odds ratio 4.3; 95% CI 1.7 to 10.7), and preoperative cholangitis (odds ratio 3.4; 95% CI 1.6 to 7.4) were risk factors for Liver Failure. These variables were included in a risk score that showed good discrimination (area under the curve 0.79; 95% CI 0.72 to 0.86) and ranking patients in 3 risk sub-groups with predicted Liver Failure incidence of 4%, 14%, and 44%. Conclusions The selection of patients for portal vein embolization using only Liver volume is insufficient, considering the other predictors of Liver Failure in PHC patients. The proposed risk score can be used for selection of patients for portal vein embolization, for adequate patient counseling, and identification of other modifiable risk factors besides Liver volume.
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remnant growth rate after portal vein embolization is a good early predictor of post hepatectomy Liver Failure
Journal of The American College of Surgeons, 2014Co-Authors: Universe Leung, Peter J Allen, Amber L Simpson, Raphael L C Araujo, Mithat Gonen, Conor Mcauliffe, Michael I Miga, Patricia E Parada, Michael I DangelicaAbstract:Background After portal vein embolization (PVE), the future Liver remnant (FLR) hypertrophies for several weeks. An early marker that predicts a low risk of post-hepatectomy Liver Failure can reduce the delay to surgery. Study Design Liver volumes of 153 patients who underwent a major hepatectomy (>3 segments) after PVE for primary or secondary Liver malignancy between September 1999 and November 2012 were retrospectively evaluated with computerized volumetry. Pre- and post-PVE FLR volume and functional Liver volume were measured. Degree of hypertrophy (DH = post-FLR/post-functional Liver volume − pre-FLR/pre-functional Liver volume) and growth rate (GR = DH/weeks since PVE) were calculated. Postoperative complications and Liver Failure were correlated with DH, measured GR, and estimated GR derived from a formula based on body surface area. Results Eligible patients underwent 93 right hepatectomies, 51 extended right hepatectomies, 4 left hepatectomies, and 5 extended left hepatectomies. Major complications occurred in 44 patients (28.7%) and Liver Failure in 6 patients (3.9%). Nonparametric regression showed that post-embolization FLR percent correlated poorly with Liver Failure. Receiver operating characteristic curves showed that DH and GR were good predictors of Liver Failure (area under the curve [AUC] = 0.80; p = 0.011 and AUC = 0.79; p = 0.015) and modest predictors of major complications (AUC = 0.66; p = 0.002 and AUC = 0.61; p = 0.032). No patient with GR >2.66% per week had Liver Failure develop. The predictive value of measured GR was superior to estimated GR for Liver Failure (AUC = 0.79 vs 0.58; p = 0.046). Conclusions Both DH and GR after PVE are strong predictors of post-hepatectomy Liver Failure. Growth rate might be a better guide for the optimum timing of Liver resection than static volumetric measurements. Measured volumetrics correlated with outcomes better than estimated volumetrics.
Ronald P Dematteo - One of the best experts on this subject based on the ideXlab platform.
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postoperative Liver Failure risk score identifying patients with resectable perihilar cholangiocarcinoma who can benefit from portal vein embolization
Journal of The American College of Surgeons, 2017Co-Authors: Pim B Olthof, Ronald P Dematteo, Jimme K Wiggers, Bas Groot Koerkamp, Robert J S Coelen, Peter J Allen, Marc G Besselink, Olivier R Busch, Michael I Dangelica, Peter T KinghamAbstract:Background Major Liver resection for perihilar cholangiocarcinoma (PHC) is associated with a 22% to 33% postoperative Liver Failure incidence. The aim of this study was analyze the predictive value of future Liver remnant (FLR) volume for postoperative Liver Failure after resection for PHC and to develop a risk score to improve patient selection for portal vein embolization. Study Design A consecutive series of 217 patients underwent major Liver resection for PHC between 1997 and 2014 at 2 Western centers; FLR volumes were calculated with CT volumetry; other variables included jaundice at presentation, immediate preoperative bilirubin, and preoperative cholangitis. The FLR volume was categorized as 45%. A risk score for postoperative Liver Failure (grade B/C according to the International Study Group of Liver Surgery criteria) was developed using multivariable logistic regression with 5 predefined variables. Results Postoperative Liver Failure incidence was 24% and Liver Failure-related mortality was 12%. Risk factors for Liver Failure were FLR volume 50 μmol/L (>2.9 mg/dL) (odds ratio 4.3; 95% CI 1.7 to 10.7), and preoperative cholangitis (odds ratio 3.4; 95% CI 1.6 to 7.4) were risk factors for Liver Failure. These variables were included in a risk score that showed good discrimination (area under the curve 0.79; 95% CI 0.72 to 0.86) and ranking patients in 3 risk sub-groups with predicted Liver Failure incidence of 4%, 14%, and 44%. Conclusions The selection of patients for portal vein embolization using only Liver volume is insufficient, considering the other predictors of Liver Failure in PHC patients. The proposed risk score can be used for selection of patients for portal vein embolization, for adequate patient counseling, and identification of other modifiable risk factors besides Liver volume.
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posthepatectomy Liver Failure a definition and grading by the international study group of Liver surgery isgls
Surgery, 2011Co-Authors: Nuh N Rahbari, James O Garden, Robert Padbury, Mark Brookesmith, Michael Crawford, Rene Adam, Moritz Koch, Masatoshi Makuuchi, Ronald P Dematteo, Christopher ChristophiAbstract:Background Posthepatectomy Liver Failure is a feared complication after hepatic resection and a major cause of perioperative mortality. There is currently no standardized definition of posthepatectomy Liver Failure that allows valid comparison of results from different studies and institutions. The aim of the current article was to propose a definition and grading of severity of posthepatectomy Liver Failure. Methods A literature search on posthepatectomy Liver Failure after hepatic resection was conducted. Based on the normal course of biochemical Liver function tests after hepatic resection, a simple and easily applicable definition of posthepatectomy Liver Failure was developed by the International Study Group of Liver Surgery. Furthermore, a grading of severity is proposed based on the impact on patients' clinical management. Results No uniform definition of posthepatectomy Liver Failure has been established in the literature addressing hepatic surgery. Considering the normal postoperative course of serum bilirubin concentration and International Normalized Ratio, we propose defining posthepatectomy Liver Failure as the impaired ability of the Liver to maintain its synthetic, excretory, and detoxifying functions, which are characterized by an increased international normalized ratio and concomitant hyperbilirubinemia (according to the normal limits of the local laboratory) on or after postoperative day 5. The severity of posthepatectomy Liver Failure should be graded based on its impact on clinical management. Grade A posthepatectomy Liver Failure requires no change of the patient's clinical management. The clinical management of patients with grade B posthepatectomy Liver Failure deviates from the regular course but does not require invasive therapy. The need for invasive treatment defines grade C posthepatectomy Liver Failure. Conclusion The current definition of posthepatectomy Liver Failure is simple and easily applicable in clinical routine. This definition can be used in future studies to allow objective and accurate comparisons of operative interventions in the field of hepatic surgery.
Peter T Kingham - One of the best experts on this subject based on the ideXlab platform.
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postoperative Liver Failure risk score identifying patients with resectable perihilar cholangiocarcinoma who can benefit from portal vein embolization
Journal of The American College of Surgeons, 2017Co-Authors: Pim B Olthof, Ronald P Dematteo, Jimme K Wiggers, Bas Groot Koerkamp, Robert J S Coelen, Peter J Allen, Marc G Besselink, Olivier R Busch, Michael I Dangelica, Peter T KinghamAbstract:Background Major Liver resection for perihilar cholangiocarcinoma (PHC) is associated with a 22% to 33% postoperative Liver Failure incidence. The aim of this study was analyze the predictive value of future Liver remnant (FLR) volume for postoperative Liver Failure after resection for PHC and to develop a risk score to improve patient selection for portal vein embolization. Study Design A consecutive series of 217 patients underwent major Liver resection for PHC between 1997 and 2014 at 2 Western centers; FLR volumes were calculated with CT volumetry; other variables included jaundice at presentation, immediate preoperative bilirubin, and preoperative cholangitis. The FLR volume was categorized as 45%. A risk score for postoperative Liver Failure (grade B/C according to the International Study Group of Liver Surgery criteria) was developed using multivariable logistic regression with 5 predefined variables. Results Postoperative Liver Failure incidence was 24% and Liver Failure-related mortality was 12%. Risk factors for Liver Failure were FLR volume 50 μmol/L (>2.9 mg/dL) (odds ratio 4.3; 95% CI 1.7 to 10.7), and preoperative cholangitis (odds ratio 3.4; 95% CI 1.6 to 7.4) were risk factors for Liver Failure. These variables were included in a risk score that showed good discrimination (area under the curve 0.79; 95% CI 0.72 to 0.86) and ranking patients in 3 risk sub-groups with predicted Liver Failure incidence of 4%, 14%, and 44%. Conclusions The selection of patients for portal vein embolization using only Liver volume is insufficient, considering the other predictors of Liver Failure in PHC patients. The proposed risk score can be used for selection of patients for portal vein embolization, for adequate patient counseling, and identification of other modifiable risk factors besides Liver volume.
Peter J Allen - One of the best experts on this subject based on the ideXlab platform.
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postoperative Liver Failure risk score identifying patients with resectable perihilar cholangiocarcinoma who can benefit from portal vein embolization
Journal of The American College of Surgeons, 2017Co-Authors: Pim B Olthof, Ronald P Dematteo, Jimme K Wiggers, Bas Groot Koerkamp, Robert J S Coelen, Peter J Allen, Marc G Besselink, Olivier R Busch, Michael I Dangelica, Peter T KinghamAbstract:Background Major Liver resection for perihilar cholangiocarcinoma (PHC) is associated with a 22% to 33% postoperative Liver Failure incidence. The aim of this study was analyze the predictive value of future Liver remnant (FLR) volume for postoperative Liver Failure after resection for PHC and to develop a risk score to improve patient selection for portal vein embolization. Study Design A consecutive series of 217 patients underwent major Liver resection for PHC between 1997 and 2014 at 2 Western centers; FLR volumes were calculated with CT volumetry; other variables included jaundice at presentation, immediate preoperative bilirubin, and preoperative cholangitis. The FLR volume was categorized as 45%. A risk score for postoperative Liver Failure (grade B/C according to the International Study Group of Liver Surgery criteria) was developed using multivariable logistic regression with 5 predefined variables. Results Postoperative Liver Failure incidence was 24% and Liver Failure-related mortality was 12%. Risk factors for Liver Failure were FLR volume 50 μmol/L (>2.9 mg/dL) (odds ratio 4.3; 95% CI 1.7 to 10.7), and preoperative cholangitis (odds ratio 3.4; 95% CI 1.6 to 7.4) were risk factors for Liver Failure. These variables were included in a risk score that showed good discrimination (area under the curve 0.79; 95% CI 0.72 to 0.86) and ranking patients in 3 risk sub-groups with predicted Liver Failure incidence of 4%, 14%, and 44%. Conclusions The selection of patients for portal vein embolization using only Liver volume is insufficient, considering the other predictors of Liver Failure in PHC patients. The proposed risk score can be used for selection of patients for portal vein embolization, for adequate patient counseling, and identification of other modifiable risk factors besides Liver volume.
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remnant growth rate after portal vein embolization is a good early predictor of post hepatectomy Liver Failure
Journal of The American College of Surgeons, 2014Co-Authors: Universe Leung, Peter J Allen, Amber L Simpson, Raphael L C Araujo, Mithat Gonen, Conor Mcauliffe, Michael I Miga, Patricia E Parada, Michael I DangelicaAbstract:Background After portal vein embolization (PVE), the future Liver remnant (FLR) hypertrophies for several weeks. An early marker that predicts a low risk of post-hepatectomy Liver Failure can reduce the delay to surgery. Study Design Liver volumes of 153 patients who underwent a major hepatectomy (>3 segments) after PVE for primary or secondary Liver malignancy between September 1999 and November 2012 were retrospectively evaluated with computerized volumetry. Pre- and post-PVE FLR volume and functional Liver volume were measured. Degree of hypertrophy (DH = post-FLR/post-functional Liver volume − pre-FLR/pre-functional Liver volume) and growth rate (GR = DH/weeks since PVE) were calculated. Postoperative complications and Liver Failure were correlated with DH, measured GR, and estimated GR derived from a formula based on body surface area. Results Eligible patients underwent 93 right hepatectomies, 51 extended right hepatectomies, 4 left hepatectomies, and 5 extended left hepatectomies. Major complications occurred in 44 patients (28.7%) and Liver Failure in 6 patients (3.9%). Nonparametric regression showed that post-embolization FLR percent correlated poorly with Liver Failure. Receiver operating characteristic curves showed that DH and GR were good predictors of Liver Failure (area under the curve [AUC] = 0.80; p = 0.011 and AUC = 0.79; p = 0.015) and modest predictors of major complications (AUC = 0.66; p = 0.002 and AUC = 0.61; p = 0.032). No patient with GR >2.66% per week had Liver Failure develop. The predictive value of measured GR was superior to estimated GR for Liver Failure (AUC = 0.79 vs 0.58; p = 0.046). Conclusions Both DH and GR after PVE are strong predictors of post-hepatectomy Liver Failure. Growth rate might be a better guide for the optimum timing of Liver resection than static volumetric measurements. Measured volumetrics correlated with outcomes better than estimated volumetrics.
Yasuo Kamiyama - One of the best experts on this subject based on the ideXlab platform.
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ha gsa rmax ratio as a predictor of postoperative Liver Failure
World Journal of Surgery, 2008Co-Authors: Masaki Kaibori, Sang Kil Hakawa, Morihiko Ishizaki, Kosuke Matsui, Takamichi Saito, Ahon Kwon, Yasuo KamiyamaAbstract:Background Postoperative mortality after hepatectomy remains high compared with other types of surgery in patients who have cirrhosis or chronic hepatitis. Although there are several useful perioperative markers of Liver dysfunction, there are no standard markers for predicting postoperative Liver Failure. This study investigated risk factors for postoperative Liver Failure after resection of hepatocellular carcinoma to detect markers that could identify candidates for hepatectomy.
