Post-operative mortality was defined as any death occurring within 30 days after surgery. 19 Tumours were classified accordingly to the sixth edition of AJCC Cancer staging manual. Tumour histological grading was assessed according to the criteria of Edmondson and Steiner based on the areas of the tumour with the highest grade. 18 Portal vein embolization (PVE) was performed 6 to 8 weeks before surgery whenever the future liver remnant (FLR) was expected to be less than 40% of the total liver volume (TLV) with the tumour volume subtracted (as calculated using three-dimensional CT volumetry). Major hepatic resection was defined as the removal of three or more segments. Operative data are shown in Tables 1 and and2. 17 Necrosis and inflammatory changes characteristic of hepatitis were scored as mild (0–5), moderate (6–12) or severe (13–18), and fibrosis was scored as cirrhosis vs. Hepatitis activity and cirrhosis were evaluated using the Isaak fibrosis score. Patients with CPT class A cirrhosis showed a median MELD score of 8, ranging from 6 to 14, significantly lower than patients with CTP class B cirrhosis who had a median MELD score of 11 (range, 9–15, P < 0.05).ĭuring hospitalization and prior to surgery, the majority of the patients received blood products such as fresh frozen plasma (FFP) in order to improve their laboratory values. An effort to subcategorize the low-from the high-risk class A patients is provided.ĭistribution of model for end-stage liver disease (MELD) in patients with cirrhosis The aim of this study was to examine whether the pre-operative MELD score can predict post-operative mortality, morbidity, hospital stay and 3-year survival in cirrhotic class A patients undergoing hepatectomy for HCC. 12 It has also been used to determine priority on waiting lists for liver transplantation 13 and in predicting post-operative outcome of cirrhotic patients, undergoing surgical procedures. MELD score is used for survival prediction in cirrhotic patients receiving a transjugular intrahepatic portosystemic shunt. 12 – 15 It has the advantage of using three objective and easily measured parameters: creatinine levels, international normalized ratio (INR) and total bilirubin. The model for end-stage liver disease (MELD) score was recently introduced to evaluate hepatic function reserve in cirrhotic patients. Many tests have been applied for the assessment of dynamic hepatic function, such as the indocyanine green clearance test, 9 lidocaine test, 10 galactose elimination capacity, 11 and it was shown that they could provide a more refined estimate of hepatic function than the CPT score. More refined evaluation of the liver function reserve isoften needed, as a result of limitations in the discriminatory ability of the CPT system, as it uses subjective parameters, such as ascites and encephalopathy. 5 – 7 CPT class A patients are generally considered good candidates for hepatic resection and good post-operative outcome is expected. 5 CPT class C is considered an absolute contraindication for surgical treatment, whereas only few hepatectomies are performed in class B cirrhosis. 3, 4 Therefore, a thorough evaluation of the hepatic function reserve is necessary prior to surgical intervention, in order to select the best candidates for hepatic resection among cirrhotic patients, with reasonable post-operative morbidity and mortality.Ĭhild–Pugh–Turcotte (CPT) classification was the first systematic approach used to determine the severity of cirrhosis and select those patients who could tolerate hepatic resection. The risk of hepatic failure in a cirrhotic patient undergoing hepatectomy still remains high, as a result of compromised function of the liver remnant. 2Įvolution in surgical techniques and peri-operative care have improved post-operative outcome, in patients with severe underlying liver disease undergoing hepatectomy. 1 The mainstay of treatment, in patients with solitary HCC and good liver function, is hepatic resection. Its incidence is 1:500 000 and it is strongly correlated with cirrhosis. Hepatocellular carcinoma (HCC) is one of the most common malignancies worldwide.
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