Published online May 15, 2021. doi: 10.4251/wjgo.v13.i5.424
Peer-review started: January 6, 2021
First decision: January 25, 2021
Revised: February 11, 2021
Accepted: April 22, 2021
Article in press: April 22, 2021
Published online: May 15, 2021
Processing time: 120 Days and 16 Hours
Given the poor synthetic function of cirrhotic liver, successful resection for patients with hepatocellular carcinoma (HCC) necessitates the ability to achieve resections with tumor free margins.
To validate post hepatectomy liver failure score (PHLF), compare it to other established systems and to stratify risks in patients with cirrhosis who underwent curative liver resection for HCC.
Between December 2010 and January 2017, 120 patients underwent curative resection for HCC in patients with cirrhosis were included, the pre-operative, operative and post-operative factors were recorded to stratify patients' risks of decompensation, survival, and PHLF.
The preoperative model for end-stage liver disease (MELD) score [odds ratio (OR) = 2.7, 95%CI: 1.2-5.7, P = 0.013], tumor diameter (OR = 5.4, 95%CI: 2-14.8, P = 0.001) and duration of hospital stay (OR = 2.5, 95%CI: 1.5-4.2, P = 0.001) were significant independent predictors of hepatic decompensation after resection. While the preoperative MELD score [hazard ratio (HR) = 1.37, 95%CI: 1.16-1.62, P < 0.001] and different grades of PHLF (grade A: HR = 2.33, 95%CI: 0.59-9.24; Grade B: HR = 3.15, 95%CI: 1.11-8.95; Grade C: HR = 373.41, 95%CI: 66.23-2105.43; P < 0.001) and HCC recurrence (HR = 11.67, 95%CI: 4.19-32.52, P < 0.001) were significant independent predictors for survival.
Preoperative MELD score and tumor diameter can independently predict hepatic decompensation. While, preoperative MELD score, different grades of PHLF and HCC recurrence can precisely predict survival.
Core Tip: The present study clearly confirmed that, in patients with cirrhosis who underwent curative resection for hepatocellular carcinoma (HCC), the preoperative model for end-stage liver disease (MELD) score, tumor diameter and the duration of hospital stay were independent predictors of decompensation. While, preoperative MELD score, different grades of post hepatectomy liver failure score and HCC recurrence were independent predictors for survival.