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Preoperative nomogram to predict posthepatectomy liver failure.

Mashaal Dhir1, Kaeli K Samson2, Natesh Yepuri1

  • 1Division of Surgical Oncology, Department of Surgery, SUNY Upstate Medical University, Syracuse, New York, USA.

Journal of Surgical Oncology
|March 23, 2021
PubMed
Summary
This summary is machine-generated.

A new nomogram accurately predicts posthepatectomy liver failure (PHLF) risk using preoperative factors. This tool aids in patient selection and counseling before liver surgery.

Keywords:
hepatectomyliver failureliver resectionnomogram

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Area of Science:

  • Hepatobiliary Surgery
  • Surgical Oncology
  • Predictive Analytics in Medicine

Background:

  • Posthepatectomy liver failure (PHLF) presents significant risks, complicating surgical planning.
  • Accurate prediction of PHLF is challenging, hindering effective patient stratification.
  • Improved preoperative risk assessment is crucial for optimizing outcomes in hepatectomy patients.

Purpose of the Study:

  • To develop and validate a preoperative nomogram for predicting PHLF.
  • To enhance risk stratification for patients undergoing partial or major hepatectomy.
  • To provide a tool for informed patient counseling and surgical decision-making.

Main Methods:

  • Utilized the hepatectomy-specific NSQIP database (2014-2016) for model development.
  • Included 10,808 patients in the initial cohort, with validation on 4,367 patients from 2017.
  • Compared patients with Grade B/C PHLF against those without liver failure.

Main Results:

  • Developed a multivariable model predicting Grade B/C PHLF with a c-statistic of 0.78.
  • Identified key preoperative predictors: male gender, biliary stent, neoadjuvant therapy, viral hepatitis, concurrent resections, biliary reconstruction, low sodium, and low albumin.
  • The nomogram demonstrated good predictive accuracy in the independent validation cohort (c-statistic 0.78).

Conclusions:

  • The developed nomogram offers patient-specific PHLF probabilities.
  • The tool is user-friendly and valuable for preoperative counseling and patient selection.
  • This nomogram can improve risk stratification and decision-making in hepatectomy procedures.