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Critical appraisal of novel prediction models and risk calculators for post-hepatectomy liver failure and complications: practicability and generalisability in the real-world setting

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Hepatobiliary Surgery and Nutrition 2024年第4期13卷 696-698页

作者： darren weiquan chua Yun Zhao Ye Xin Koh Department of Hepatopancreatobiliary and Transplant Surgery Singapore General Hospital and National Cancer Centre SingaporeSingaporeSingapore Duke-National University of Singapore Medical School SingaporeSingapore Liver Transplant Service SingHealth Duke-National University of Singapore Transplant CentreSingaporeSingapore

Over the last few decades,the evolution of liver resection has progressed through numerous milestones in peri-operative management,operative techniques and novel technologies that have dramatically improved patient safety and outcomes(1).Consequently,such developments have enabled surgeons to embark on liver resections of lesions in technically challenging locations,whereby extended resection or bilovascular reconstruction may be required to ensure oncologic *** the context of extended resections or resection of lesions from heavily diseased livers,concerns remain regarding the adequacy of the remnant future liver remnant(FLR)and liver function,placing patients at risk of the clinical phenomenon known as post-hepatectomy liver failure(PHLF).Although relatively uncommon,PHLF has a reported incidence of up to 32%in the literature and remains an important cause of post-hepatectomy morbidity and mortality(2).Presently,several definitions have been proposed to describe PHLF,the most recent of which was proposed by the International Study Group of Liver Surgery(ISGLS).In this definition,PHLF was defined as an increased international normalized ratio(INR)or hyperbilirubinemia on or after post-operative day 5,with further stratification of severity grades(A,B or C)based on the extent of clinical management(3).While definitions in PHLF assist in providing a common diagnostic framework among physicians,establishing predictors in PHLF is conceivably more helpful as it allows surgeons to have important decision-making details prior to planned liver resection.

关键词： Hepatectomy post-hepatectomy liver failure(PHLF) predictive model risk calculation

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