Safe Valadition Of Different Decision Trees And Risk Factors For Hepatectomy In Hepatocellular Patients

Part One. Safety validation of decision trees for hepatocellular carcinomaAIM:To evaluate different dicision tree for safe liver resection and verify its efficiency.METHODS:A total of 2,457 patients underwent hepatic resection between January 2004 and December 2010 in PLA GENERAL Hospital, and 634 HCC patients were eligible for the final analyses. PHLF has been identified by the association of prothrombin time <50% and serum bilirubin >50 micromol/L (the "50-50" criteria), which were assessed at day 5 postoperatively or later. The Swiss-Clavien decision tree, Tokyo University-Makuuchi decision tree, and Chinees consensus decision tree were adopted to divide patients into two groups based on those decision trees in sequence, and the PHLF rates were recorded.RESULTS:The overall mortality and PHLF rate were 0.16% and 3.0%. A total of 19 patients experienced PHLF. The numbers of patients to whom the Swiss-Clavien, Tokyo university-Makuuchi, and Chinees consensus decision trees were applied were 581,573, and 622, and the PHLF rates were 2.75%,2.62%, and 2.73%, respectively. Significantly more cases satisfied the Chinees consensus decision tree than the Swiss-Clavien decision tree and Tokyo university-Makuuchi decision tree (p<0.01, p<0.01); nevertheless, the latter two shared no difference (p=0.147). The PHLF rate exhibited no significant difference with respect to the three decision trees.CONCLUSION:The Chinese consensus decision tree expands the indications for hepatic resection for HCC patients and does not increase the PHLF rate compared to the Swiss-Clavien and Tokyo university-Makuuchi decision trees. It would be a safe and effective algorithm for hepatectomy in patients with hepatocellular carcinoma.Part Two. Spleen to Standardized liver volume ratio can predict postoperative complicationsAIM:To evaluate the predict value of spleen to standardized liver volume ratio.METHODS:From Jan 2012 to Dec 2012, a consecutive cohort of HCC patients were studied and 106 cases were enrolled. ROC analysis was applied to find the cut-off value of parameters for postoperative morbidity and mortality. Multiple variable analysis was used to found the predictors of postoperative complicaitons.RESULTS:The 90-day mortality rate is 6.0%,14 cased is diagnosed as mild complications,4 for sever classifications. SpV-SLV and SpV-FLV has close relationship (R=0.904). In predicting postoperative complication, SpV-SLV and SpV-FLV has same effect(AUC 0.652 vs.0.648,95%CI,0.511-0.792 vs.0.505-0.791)。 The cut-off value of SpV-SLV is 38%, with sensitivity and specificity for42.9%and 91.3%. Multiple variable analysis demonstrates SpV-SLV>38%、ICGR15 and blood loss>1000mL are independent risk factors for postoperative complications.CONCLUSION:SpV-SLV and SpV-FLV has close relationship. SpV-SLV>38%、 ICGR15 and blood loss>1000mL can predict postoperative complications.