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1 . 2023

Evaluation of prognostic criteria for the development of postoperative complications of liver resection in its focal diseases

Abstract

Background. The incidence rate of focal liver formations and its predicted growth in the future, the relevance of liver metastases suggests an increase in the number of liver resections and encourages the development of this direction. To improve the quality and results of treatment, including by reducing the frequency of postoperative complications, a personalized approach in determining the tactics of treating patient will help. It is possible to implement this approach by examining the predictors of postoperative complications.

Aim. To determine prognostic criteria for the development of postoperative complications.

Material and methods. In accordance with the inclusion, non-inclusion and exclusion

criteria, 66 patients were selected for the study. All of them underwent liver resection of various sizes. Next, dependent and independent variables were determined to evaluate the prognostic criteria. For each independent variable, the odds ratio (OR) and significance level (p) were calculated. Risk factors were assessed at the preoperative, operative and postoperative stages.

Results. The following risk factors turned out to be common for all: AST level (≥30–38.7 U/l, p<0.05), PTI level (≤80–92%; p<0.05), fibrinogen (≥ 3.98–5.74 g/l, p<0.05) before surgery; AST level (≥346–741 U/l; p<0.05), total bilirubin level (≥27.5–30 µmol/l; p<0.05) on day 1 after surgery. In addition to the indicators of laboratory diagnostics, the duration of the operation (≥315–390 min; p<0.05), intraoperative blood loss (≥330–740 ml; p<0.05), intra- and postoperative transfusion of blood components (p<0.02), resection of 3 or more segments (p<0.05).

Conclusion. The results of the study showed that the patient’s age, the amount of surgical aid, the duration of the operation and intraoperative blood loss, transfusion of blood components during and after the operation, the results of laboratory diagnostics (such as the level of hepatic transferases, total bilirubin, fibrinogen, protrombin index) can be statistically significant predictors of postoperative complications. These criteria can be used to build complex prognostic models that will be in demand in clinical practice.

Keywords:liver; liver resection; postoperative complication; prognostic criteria; perioperative planning

Funding. The study had no sponsor support.
Conflict of interest. The authors declare no conflict of interest.
For citation: Subbot V.S., Semenkov A.V., Tulskih D.А. Evaluation of prognostic criteria for the development of postoperative complications of liver resection in its focal diseases. Clinical and Experimental Surgery. Petrovsky Journal. 2023; 11 (1): 104–12. DOI: https://doi.org/10.33029/2308-1198-2023-11-1-104-112  (in Russian)

References

1.     Sung H., et al. Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021; 71 (3): 209–49. DOI: DOI: https://doi.org/10.3322/caac.21660   

2.     The state of oncological care for the population of Russia in 2020. In: A.D. Kaprin, V.V. Starinsky, A.O. Shakhzadova (eds). Moscow, 2021: 239 p. (in Russian)

3.     Hess K.R., et al. Metastatic patterns in adenocarcinoma. Cancer. 2006; 106 (7): 1624–33. DOI: https://doi.org/10.1002/cncr.21778  

4.     Brodt P. Role of the microenvironment in liver metastasis: From pre- to prometastatic niches. Clin Cancer Res. 2016; 22 (24): 5971–82. DOI: https://doi.org/10.1158/1078-0432.CCR-16-0460  

5.     Borsukov A.V., Kovalenko E.S., Momdzhyan B.K. Clinical opportunities of an interventional radiology in local treatment of metastatic cancer of a liver. Meditsinskaya vizualizatsiya [Medical Imaging]. 2007; (2): 50–8. (in Russian)

6.     Zogot S.R., Akberov R.F. Frequency and X-ray semiotics of liver metastasis of various location tumors on the results of a comprehensive radioligic study. Prakticheskaya meditsina [Practical Medicine]. 2013; 2 (67): 119–22. (in Russian)

7.     Kaprin A.D., Alieva S.B., et al. Clinical guidelines: Liver cancer (hepatocellular). Moscow, 2022. URL: https://cr.minzdrav.gov.ru/recomend/1_3  (date of access September 13, .2022). (in Russian)

8.     Breder V.V., Balakhnin P.V., Virshke E.R., Kosyrev V.Yu., Ledin E.V., Petkau V.V. Practical recommendations for drug treatment of patients with hepatocellular cancer. Zlokachestvennye opukholi [Malignant Tumours]. 2021; 11 (3s2-1): 431–51. DOI: https://doi.org/10.18027/2224-5057-2021-11-3s2-25   (in Russian)

9.     Reig M., et al. BCLC strategy for prognosis prediction and treatment recommendation: The 2022 update. J Hepatol. 2022; 76 (3): 681–93. DOI: https://doi.org/10.1016/j.jhep.2021.11.018   

10. Berardi G., et al. Development of a nomogram to predict outcome after liver resection for hepatocellular carcinoma in Child-Pugh B cirrhosis. J Hepatol. 2020; 72 (1): 75–84. DOI: https://doi.org/10.1016/j.jhep.2019.08.032  

11. Akgül Ö.  Role of surgery in colorectal cancer liver metastases. World J Gastroenterol. 2014; 20 (20): 6113. DOI: https://doi.org/10.3748/wjg.v20.i20.6113  

12. Ito K., Govindarajan A., Ito H., Fong Y. Surgical Treatment of Hepatic Colorectal Metastasis Evolving Role in the Setting of Improving Systemic Therapies and Ablative Treatments in the 21st Century [Electronic resource]. 2010. URL: www.journalppo.com  

13. Fedyanin M.Yu., et al. Practical recommendations for drug treatment of colon cancer and rectosigmoid junction. Zlokachestvennye opukholi [Malignant Tumours]. 2021; 10 (3s2-1): 350–91. DOI: https://doi.org/10.18027/2224-5057-2020-10-3s2-22  (in Russian)

14. Chakedis J., Schmidt C.R. Surgical treatment of metastatic colorectal cancer. Surg Oncol Clin North Am. 2018; 27 (2): 377–99. DOI: https://doi.org/10.1016/j.soc.2017.11.010  

15. O’Rafferty C., O’Regan G.M., Irvine A.D., Smith O.P. Recent advances in the pathobiology and management of Kasabach-Merritt phenomenon. Br J Haematol. 2015; 171 (1): 38–51. DOI: https://doi.org/10.1111/bjh.13557  

16. Hall G.W. Kasabach-Merritt syndrome: Pathogenesis and management. Br J Haematol. 2001; 112 (4): 851–62. DOI: https://doi.org/10.1046/j.1365-2141.2001.02453.x  

17. Eisenhauer E.A., et al. New response evaluation criteria in solid tumours: Revised RECIST guideline (version 1.1). Eur J Cancer. 2009; 45 (2): 228–47. DOI: https://doi.org/10.1016/j.ejca.2008.10.026  

18. Jin S., Fu Q., Wuyun G., Wuyun T. Management of post-hepatectomy complications. World J Gastroenterol. 2013; 19 (44): 7983–91. DOI: https://doi.org/10.3748/wjg.v19.i44.7983   

19. Abreu P., et al. Liver resections for metastasis: surgical outcomes of a single center academic institution. BMC Surg. 2020; 20 (1): 254. DOI: https://doi.org/10.1186/s12893-020-00920-7  

20. Rössler F., et al. Defining benchmarks for major liver surgery: A multicenter analysis of 5202 living liver donors. Ann Surg. 2016; 264 (3): 492–9. DOI: https://doi.org/10.1097/SLA.0000000000001849  

21. Benkabbou A., et al. Risk factors for major complications after liver resection: A large liver resection study from Morocco and audit of a non-Eastern/non-Western experience. Arab J Gastroenterol. 2021; 22 (3): 229–35. DOI: https://doi.org/10.1016/j.ajg.2021.05.019  

22. Kajiwara T., et al. Clinical score to predict the risk of bile leakage after liver resection. BMC Surg. 2016; 16 (1): 30. DOI: https://doi.org/10.1186/s12893-016-0147-0  

23. Patyutko Yu.I., Mamontov K.G., Kotelnikov A.G., Ponomarenko A.A., et al. Major liver resections with preoperative regional chemotherapy for colorectal cancer metastases. Rossiyskiy onkologicheskiy zhurnal [Russian Journal of Cancer]. 2014; (2): 4–11. (in Russian)

24. Patyutko Yu.I., Kotel’nikov A.G., Mamontov K.G., et al. Immediate results of liver resections for colorectal cancer metastases. Onkologicheskaya koloproktologiya [Oncological Coloproctology]. 20114; (1): 14–20. (in Russian)

25. Patyutko Yu.I., Sagaydak I.V., Kotel’nikov A.G., et al. Liver resection: modern technologies for tumor lesions. Annaly khirurgicheskoy gepatologii [Annals of Surgical Hepatology]. 2010; 15 (2): 9–17. (in Russian)

26. Rahbari N.N., et al. Posthepatectomy liver failure: A definition and grading by the International Study Group of Liver Surgery (ISGLS). Surgery. 2011; 149 (5): 713–24. DOI: https://doi.org/10.1016/j.surg.2010.10.001  

27. Benzoni E., et al. Resective surgery for liver tumor: a multivariate analysis of causes and risk factors linked to postoperative complications. Hepatobiliary Pancreat Dis Int. 2006; 5 (4): 526–33.

28. Jarnagin W.R., et al. Improvement in perioperative outcome after hepatic resection analysis of 1,803 consecutive cases over the past decade. Ann Surg. 2002; 236 (4): 397–407. DOI: https://doi.org/10.1097/01.SLA.0000029003.66466.B3  

29. Benzoni E., et al. Liver resection for HCC: Analysis of causes and risk factors linked to postoperative complications [Electronic resource]. Hepatogastroenterology. 2007; 54 (73): 186–9. URL: http://www.ncbi.nlm.nih.gov/pubmed/17419257  

30. Katz S.C., et al. Operative blood loss independently predicts recurrence and survival after resection of hepatocellular carcinoma. Ann Surg. 2009; 249 (4): 617–23. DOI: https://doi.org/10.1097/SLA.0b013e31819ed22f  

31. Sushinskaya T.V., Stuklov N.I., Dobrokhotova Yu.E. Hemostasis and cancer-associated thrombosis: Modern prevention and treatment. Onkologiya. Zhurnal imeni P.A. Gertsena [Oncology. Journal named after P.A. Gertsen]. 2018; 7 (4): 64–72. DOI: https://doi.org/10.17116/onkolog20187464   (in Russian)

32. Banz V.M., Studer P., Inderbitzin D., Candinas D. Validation of the estimation of physiologic ability and surgical stress (E-PASS) score in liver surgery. World J Surg. 2009; 33 (6): 1259–65. DOI: https://doi.org/10.1007/s00268-009-9989-2  

33. Schroeder R.A., Marroquin C.E., Bute B., Khuri S., Henderson W.G., Kuo P.C. Predictive indices of morbidity and mortality after liver resection. Ann Surg. 2006; 243: 373–9. DOI: https://doi.org/10.1097/01.sla.0000201483.95911.08  

34. Chen T., Wang H., Wang H., Song Y., Li X., Wang J. POSSUM and P-POSSUM as predictors of postoperative morbidity and mortality in patients undergoing hepato-biliary-pancreatic surgery: A meta-analysis. Ann Surg Oncol. 2013; 20 (8): 2501–10. DOI: https://doi.org/10.1245/s10434-013-2893-x  

35. Madhavan S., et al. Predicting morbidity of liver resection. Langenbecks Arch Surg. 2018; 403 (3): 359–69. DOI: https://doi.org/10.1007/s00423-018-1656-3  

36. Skipenko O.G., Bedzhanyan A.L., Polishchuk L.O. The role of prognostic models in metastatic colorectal liver cancer surgery. Khirurgiya. Zhurnal imeni N.I. Pirogova [Surgery. The Journal  Named after N.I. Pirogov]. 2015; (12): 56–71. DOI: https://doi.org/10.17116/hirurgia20151256-71  PMID: 26978765. (in English, Russian)

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CHIEF EDITOR
CHIEF EDITOR
Sergey L. Dzemeshkevich
MD, Professor (Moscow, Russia)

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