Morphologic severity of cirrhosis determines the extent of liver resection in patients with hepatocellular carcinoma and Child-Pugh grade A cirrhosis

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• 作者：Shao-jun Zhou ; MD^a ; ^b ; Er-lei Zhang ; MD^b ; Bin-yong Liang ; MD^b ; Zun-yi Zhang ; MD^b ; Ke-shuai Dong ; BS^b ; Ping Hou ; MS^c ; Xiao-ping Chen ; MD^b ; Min Xiong ; MD^d ; ^{karren126@126.com" class="auth_mail" title="E-mail the corresponding author} ; Zhi-yong Huang ; MD^b ; ^{zyhuang2015@hotmail.com" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Liver cirrhosis ; Hepatectomy ; Hepatocellular carcinoma ; Post-hepatectomy liver failure
• 刊名：Journal of Surgical Research
• 出版年：2016
• 出版时间：February 2016
• 年：2016
• 卷：200
• 期：2
• 页码：444-451
• 全文大小：1084 K

文摘

Liver resection is the mainstay of treatment for patients with hepatocellular carcinoma and compensated cirrhosis. We investigated the relationship between the morphologic severity of cirrhosis and post-hepatectomy liver failure (PHLF) and evaluated the role of cirrhosis staging in determination of the extent limit for liver resection.

Methods

The clinicopathologic data of 672 consecutive patients with Child–Pugh grade A liver function who underwent curative liver resection for hepatocellular carcinoma in Tongji Hospital from 2009 to 2013 were retrospectively reviewed. Severity of cirrhosis was staged morphologically and histologically. Risk factors for histologic cirrhosis and PHLF were analyzed. The extent limit of liver resection with reference to morphologic staging was studied.

Results

Morphologic and histologic stages were significantly correlated (τ = 0.809, P < 0.001). Multivariate analysis showed that morphologic staging was the most crucial factor for histologic cirrhosis (odds ratio = 26.99, 95% confidence interval = 16.88–43.14, P < 0.001) and PHLF (odds ratio = 11.48, 95% confidence interval = 6.04–21.82, P < 0.001). The incidence of PHLF was high in patients with mild cirrhosis after resection of four or more liver segments (13.6%), those with moderate cirrhosis after major resection (38.1%), and those with severe cirrhosis or severe portal hypertension after resection of two or more liver segments (63.2% and 50.0%, respectively).

Conclusions

Morphologic severity of cirrhosis is an independent predictor of PHLF. Resection of fewer than four liver segments is justified in patients with mild cirrhosis. Major resection is not recommended in patients with moderate cirrhosis. In patients with severe cirrhosis or severe portal hypertension, only resection of fewer than two liver segments can be safely performed.