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

Rompianesi, Gianluca; Ielpo, Benedetto; Burdío Pinilla, Fernando; Troisi, Roberto Ivan

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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dc.contributor.author Rompianesi, Gianluca
dc.contributor.author Ielpo, Benedetto
dc.contributor.author Burdío Pinilla, Fernando
dc.contributor.author Troisi, Roberto Ivan
dc.contributor.other Rompianesi, Gianluca; Ielpo, Benedetto; Burdío Pinilla, Fernando; Troisi, Roberto Ivan
dc.date.accessioned 2025-01-15T07:34:48Z
dc.date.available 2025-01-15T07:34:48Z
dc.date.issued 2024
dc.description Data de publicació electrònica: 22-10-2024
dc.description.abstract Background: Post-hepatectomy liver failure (PHLF) can significantly compromise outcomes, especially in cirrhotic patients. The identification of accurate and non-invasive pre-operative predictors is of paramount importance to appropriately stratify patients according to their estimated risk and select the best treatment strategy. Materials and methods: Consecutive patients undergoing liver resection for HCC on cirrhosis between 1-2015 and 12-2020 at 10 international Institutions were enrolled and their pre-operative CT scans were evaluated for the presence of spontaneous portosystemic shunts (SPSS) to identify predictors of PHLF and develop a nomogram. Results: The analysis of the CT scans identified SPSS in 74 patients (17.4 %). PHLF was developed in 27 out of 425 cases (6.4 %), with grades B/C observed in 17 patients (4 %). At the multivariable analysis, the presence of SPSS resulted an independent risk factor for all-grades PHLF (OR 6.83, 95%CI 2.39-19.51, p < 0.001) and clinically significant PHLF development (OR 7.92, 95%CI 2.03-30.85, p = 0.003) alongside a patient's age ≥74 years, a pre-operative platelets count <106x103/μL, a multiple-segments liver resection, and an intraoperative blood loss ≥1200 mL. The 30- and 90-days mortality in patients with and without SPSS resulted 2.7 % vs 0.3 % (p = 0.024) and 5.4 % vs 1.1 % (p = 0.014). The accuracy of SPSS in predicting PHLF development was 0.847 (95%n CI 0.809-0.880). The internally validated nomogram showed excellent performance in predicting grades B/C PHLF (c-statistic = 0.933 (95%CI 0.888-0.979)). Conclusion: The pre-operative presence of SPSS assessed on the pre-operative imaging proved to be a valuable radiological biomarker able to predict PHLF development in patients undergoing liver resection for HCC.
dc.format.mimetype application/pdf
dc.identifier.citation Rompianesi G, Han HS, Fusai G, Lopez-Ben S, Maestri M, Ercolani G, et al. Pre-operative evaluation of spontaneous portosystemic shunts as a predictor of post-hepatectomy liver failure in patients undergoing liver resection for hepatocellular carcinoma. Eur J Surg Oncol. 2024 Oct 22:108778. DOI: 10.1016/j.ejso.2024.108778
dc.identifier.doi http://dx.doi.org/10.1016/j.ejso.2024.108778
dc.identifier.issn 0748-7983
dc.identifier.uri http://hdl.handle.net/10230/69132
dc.language.iso eng
dc.publisher Elsevier
dc.relation.ispartof Eur J Surg Oncol. 2024 Oct 22:108778
dc.rights.accessRights info:eu-repo/semantics/openAccess
dc.rights.uri http://creativecommons.org/licenses/by-nc-nd/4.0/
dc.subject.keyword Hepatocellular carcinoma
dc.subject.keyword Liver resection
dc.subject.keyword Liver surgery
dc.subject.keyword Post-hepatectomy liver failure
dc.subject.keyword Spontaneous portosystemic shunts
dc.title Pre-operative evaluation of spontaneous portosystemic shunts as a predictor of post-hepatectomy liver failure in patients undergoing liver resection for hepatocellular carcinoma
dc.type info:eu-repo/semantics/article
dc.type.version info:eu-repo/semantics/publishedVersion

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