RT Journal
A1 Oussoultzoglou E, Jaeck D, Addeo P, et al
T1 PRediction of mortality rate after major hepatectomy in patients without cirrhosis
JF Archives of Surgery
JO Archives of Surgery
YR 2010
FD November 15
VO 145
IS 11
SP 1075
OP 1081
DO 10.1001/archsurg.2010.225
UL http://dx.doi.org/10.1001/archsurg.2010.225
AB Objective 
    To assess the ability of preoperative biological parameters to predict a fatal outcome after a major liver resection in patients without cirrhosis.Design 
    Retrospective descriptive cohort study.Setting 
    Department of Digestive Surgery and Transplantation, University of Strasbourg.Patients 
    From January 1, 2004, through December 31, 2007, 67 consecutive patients underwent resection of at least 4 contiguous liver segments.Main Outcome Measures 
    Perioperative data were prospectively recorded, and predictors of postoperative mortality rate and liver failure were analyzed.Results 
    Five patients (7%) died after a mean (SD) of 32.4 (11.8) postoperative days. The overall morbidity was 73% (49 patients). Univariate analysis revealed that a preoperative alanine aminotransferase blood level greater than 40 U/L (to convert to microkatals per liter, multiply by 0.0167), a preoperative prothrombin ratio less than 70%, a preoperative Indocyanine green retention rate at 15 minutes of greater than 15%, preoperative biliary drainage, and performance of extrahepatic bile duct resection significantly predict the occurrence of in-hospital death. The number of preoperative biological parameters in each patient significantly increased the mortality rate. Indeed, the mortalities were 0%, 3%, and 67% in patients presenting with none, 1, and 2 or more risk factors, respectively.Conclusions 
    This study shows that preoperative liver tests and function can predict postoperative fatal outcome in patients presenting with biliary carcinomas and requiring a major liver resection. On the basis of these preoperative biological parameters, a decision-making algorithm is provided.