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Pre-operative Evaluation Of Spontaneous Portosystemic Shunts As A Predictor Of Post-hepatectomy Liver Failure In Patients Undergoing Liver Resection For Hepatocellular Carcinoma.

Home
Research Domains
Biomedical And Clinical Sciences
Oncology And Carcinogenesis
Predictive And Prognostic Markers
Pre-operative Evaluation Of Spontaneous Portosystemic Shunts As A Predictor Of Post-hepatectomy Liver Failure In Patients Undergoing Liver Resection For Hepatocellular Carcinoma.

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Pre-operative evaluation of spontaneous portosystemic shunts as a predictor of post-hepatectomy liver failure in patients undergoing liver resection for hepatocellular carcinoma.

Gianluca Rompianesi¹, Ho-Seong Han², Giuseppe Fusai³

¹HPB, Minimally Invasive, Robotic and Transplant Surgery Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy.

European Journal of Surgical Oncology : the Journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology

|November 3, 2024

View abstract on PubMed

Summary

This summary is machine-generated.

Keywords:

Hepatocellular carcinoma Liver resection Liver surgery Post-hepatectomy liver failure

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Spontaneous portosystemic shunts (SPSS) on pre-operative imaging are a significant predictor of post-hepatectomy liver failure (PHLF) in patients with hepatocellular carcinoma on cirrhosis. Identifying SPSS aids in risk stratification and surgical planning for liver resection.

Area of Science:

Hepatobiliary Surgery
Radiology
Oncology

Background:

Post-hepatectomy liver failure (PHLF) is a major complication after liver resection, particularly in patients with cirrhosis.
Accurate pre-operative risk assessment is crucial for patient stratification and treatment planning.

Purpose of the Study:

To identify pre-operative predictors of PHLF in patients undergoing liver resection for hepatocellular carcinoma (HCC) on cirrhosis.
To evaluate the role of spontaneous portosystemic shunts (SPSS) as a predictor of PHLF.

Main Methods:

A multi-institutional study of consecutive patients undergoing liver resection for HCC on cirrhosis from 2015-2020.
Pre-operative CT scans were analyzed for the presence of SPSS.
Multivariable analysis was used to identify independent risk factors for PHLF.

Spontaneous portosystemic shunts

Main Results:

Spontaneous portosystemic shunts (SPSS) were identified in 17.4% of patients.
SPSS was an independent predictor of all-grade PHLF (OR 6.83) and clinically significant PHLF (OR 7.92).
SPSS presence was associated with increased 30- and 90-day mortality and demonstrated high accuracy (0.847) in predicting PHLF.

Conclusions:

Pre-operative SPSS detected on imaging is a valuable radiological biomarker for predicting PHLF after liver resection for HCC.
The presence of SPSS should be considered in the pre-operative risk assessment for liver resection in cirrhotic patients.
A validated nomogram incorporating SPSS shows excellent performance in predicting severe PHLF.