Extended hepatic resection is a major surgical procedure that may be associated with significant perioperative mortality. Identification of specific risk factors can identify patients at high risk for mortality. The authors are from Memorial Sloan-Kettering Cancer Center and the University of Ferrara (Italy).
Extended hepatic resections = resection of 4 or more hepatic segments:
(1) right extended hepatectomy: segments IV to VIII
(2) left extended hepatectomy: segments II-V and VIII
Indications for an extended hepatic resection:
(1) large primary hepatic tumors
(2) metatastic tumors to the liver
|
Risk Factor |
Finding |
Points |
|
cholangitis |
absent |
0 |
|
|
present |
1 |
|
serum creatinine |
<= 1.3 mg/dL |
0 |
|
|
> 1.3 mg/dL |
1 |
|
total bilirubin |
<= 6.0 mg/dL |
0 |
|
|
> 6.0 mg/dL |
1 |
|
blood loss during surgery |
<= 3 liters |
0 |
|
|
> 3 liters |
1 |
|
vena caval resection |
not performed |
0 |
|
|
performed |
1 |
number of risk factors =
= SUM(points for all 5 risk factors)
Interpretation:
• minimum number of risk factors: 0
• maximum number of risk factors: 5
• Perioperative mortality increases as the number of risk factors increases.
• The presence of 2 or 3 of the 3 preoperatively known variables can be used to better advise the patient and family of the high operative risks.
|
Number of Risk Factors |
Mortality |
|
0 |
3% |
|
1 |
10% |
|
>= 2 |
100% |
Specialty: Gastroenterology, Surgery, general, Surgery, orthopedic
ICD-10: ,
