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Which Is the Better Predictor of Hepatic Reserve Prior to Liver Resection: MELD or the Child-Pugh Score?

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Difficult Decisions in Hepatobiliary and Pancreatic Surgery

Part of the book series: Difficult Decisions in Surgery: An Evidence-Based Approach ((DDSURGERY))

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Abstract

Critical assessment of the hepatic reserve is essential prior to liver resection especially in patients with chronic liver disease. Development of liver dysfunction post resection can result in a significant increase in associated complications resulting in prolonged length of hospital stay and increased hospital costs. In addition, the development of liver failure is almost universally fatal unless the patient can undergo liver transplantation. Several scoring systems have been identified which assess the degree of liver disease including the Child-Turcotte-Pugh scoring system (CTP) and the Model for End Stage Liver Disease (MELD). Both of these scoring systems have been used to predict mortality post liver resection. Based on the current available literature, MELD appears to be the best predictor of postoperative liver dysfunction/failure in patients with cirrhosis, and patients with MELD scores ≥9 should not be considered for hepatic resection. Other factors not included in MELD such as platelet count, presence of portal hypertension, extent of liver resection (and the resulting residual liver volume) and the presence of ascites should also be considered when selecting patients with chronic liver disease to undergo liver resection.

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References

  1. Mittal S, El-Serag HB. Epidemiology of hepatocellular carcinoma: consider the population. J Clin Gastroenterol. 2013;47(Suppl):S2–6.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Smith JM, Biggins SW, Haselby DG, Kim WR, Wedd J, Lamb K, et al. Kidney, pancreas and liver allocation and distribution in the United States. Am J Transplant. 2012;12(12):3191–212.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Rahbari NN, Garden OJ, Padbury R, Brooke-Smith M, Crawford M, Adam R, et al. Posthepatectomy liver failure: a definition and grading by the International Study Group of Liver Surgery (ISGLS). Surgery. 2011;149(5):713–24.

    Article  PubMed  Google Scholar 

  4. Fukushima K, Fukumoto T, Kuramitsu K, Kido M, Takebe A, Tanaka M, et al. Assessment of ISGLS definition of posthepatectomy liver failure and its effect on outcome in patients with hepatocellular carcinoma. J Gastrointest Surg. 2014;18(4):729–36.

    Article  PubMed  Google Scholar 

  5. Garrison RN, Cryer HM, Howard DA, Polk Jr HC. Clarification of risk factors for abdominal operations in patients with hepatic cirrhosis. Ann Surg. 1984;199(6):648–55.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Mansour A, Watson W, Shayani V, Pickleman J. Abdominal operations in patients with cirrhosis: still a major surgical challenge. Surgery. 1997;122(4):730–5; discussion 5–6.

    Article  CAS  PubMed  Google Scholar 

  7. Child C, Turcotte JG. Surgery and portal hypertension. In: Child C, editor. The liver and portal hypertension. Philadelphia: Saunders; 1964. p. 50–64.

    Google Scholar 

  8. Pugh RN, Murray-Lyon IM, Dawson JL, Pietroni MC, Williams R. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg. 1973;60(8):646–9.

    Article  CAS  PubMed  Google Scholar 

  9. Malinchoc M, Kamath PS, Gordon FD, Peine CJ, Rank J, ter Borg PC. A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts. Hepatology. 2000;31(4):864–71.

    Article  CAS  PubMed  Google Scholar 

  10. Kamath PS, Wiesner RH, Malinchoc M, Kremers W, Therneau TM, Kosberg CL, et al. A model to predict survival in patients with end-stage liver disease. Hepatology. 2001;33(2):464–70.

    Article  CAS  PubMed  Google Scholar 

  11. Befeler AS, Palmer DE, Hoffman M, Longo W, Solomon H, Di Bisceglie AM. The safety of intra-abdominal surgery in patients with cirrhosis: model for end-stage liver disease score is superior to Child-Turcotte-Pugh classification in predicting outcome. Arch Surg. 2005;140(7):650–4; discussion 5.

    Article  PubMed  Google Scholar 

  12. Nagasue N, Kohno H, Tachibana M, Yamanoi A, Ohmori H, El-Assal ON. Prognostic factors after hepatic resection for hepatocellular carcinoma associated with Child-Turcotte class B and C cirrhosis. Ann Surg. 1999;229(1):84–90.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Nakahara H, Itamoto T, Katayama K, Ohdan H, Hino H, Ochi M, et al. Indication of hepatectomy for cirrhotic patients with hepatocellular carcinoma classified as Child-Pugh class B. World J Surg. 2005;29(6):734–8.

    Article  PubMed  Google Scholar 

  14. Kuroda S, Tashiro H, Kobayashi T, Oshita A, Amano H, Ohdan H. Selection criteria for hepatectomy in patients with hepatocellular carcinoma classified as Child-Pugh class B. World J Surg. 2011;35(4):834–41.

    Article  PubMed  Google Scholar 

  15. Fan ST, Lo CM, Liu CL, Lam CM, Yuen WK, Yeung C, et al. Hepatectomy for hepatocellular carcinoma: toward zero hospital deaths. Ann Surg. 1999;229(3):322–30.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Lau H, Man K, Fan ST, Yu WC, Lo CM, Wong J. Evaluation of preoperative hepatic function in patients with hepatocellular carcinoma undergoing hepatectomy. Br J Surg. 1997;84(9):1255–9.

    Article  CAS  PubMed  Google Scholar 

  17. Taketomi A, Kitagawa D, Itoh S, Harimoto N, Yamashita Y, Gion T, et al. Trends in morbidity and mortality after hepatic resection for hepatocellular carcinoma: an institute’s experience with 625 patients. J Am Coll Surg. 2007;204(4):580–7.

    Article  PubMed  Google Scholar 

  18. Nagasue N, Kohno H, Chang YC, Taniura H, Yamanoi A, Uchida M, et al. Liver resection for hepatocellular carcinoma. Results of 229 consecutive patients during 11 years. Ann Surg. 1993;217(4):375–84.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Farges O, Malassagne B, Flejou JF, Balzan S, Sauvanet A, Belghiti J. Risk of major liver resection in patients with underlying chronic liver disease: a reappraisal. Ann Surg. 1999;229(2):210–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Yang T, Zhang J, Lu JH, Yang GS, Wu MC, Yu WF. Risk factors influencing postoperative outcomes of major hepatic resection of hepatocellular carcinoma for patients with underlying liver diseases. World J Surg. 2011;35(9):2073–82.

    Article  PubMed  Google Scholar 

  21. Zhou L, Rui JA, Wang SB, Chen SG, Qu Q, Chi TY, et al. Outcomes and prognostic factors of cirrhotic patients with hepatocellular carcinoma after radical major hepatectomy. World J Surg. 2007;31(9):1782–7.

    Article  PubMed  Google Scholar 

  22. Marrero JA, Fontana RJ, Barrat A, Askari F, Conjeevaram HS, Su GL, et al. Prognosis of hepatocellular carcinoma: comparison of 7 staging systems in an American cohort. Hepatology. 2005;41(4):707–16.

    Article  PubMed  Google Scholar 

  23. Teh SH, Christein J, Donohue J, Que F, Kendrick M, Farnell M, et al. Hepatic resection of hepatocellular carcinoma in patients with cirrhosis: Model of End-Stage Liver Disease (MELD) score predicts perioperative mortality. J Gastrointest Surg. 2005;9(9):1207–15; discussion 15.

    Article  PubMed  Google Scholar 

  24. Cucchetti A, Ercolani G, Cescon M, Ravaioli M, Zanello M, Del Gaudio M, et al. Recovery from liver failure after hepatectomy for hepatocellular carcinoma in cirrhosis: meaning of the model for end-stage liver disease. J Am Coll Surg. 2006;203(5):670–6.

    Article  PubMed  Google Scholar 

  25. Delis SG, Bakoyiannis A, Biliatis I, Athanassiou K, Tassopoulos N, Dervenis C. Model for end-stage liver disease (MELD) score, as a prognostic factor for post-operative morbidity and mortality in cirrhotic patients, undergoing hepatectomy for hepatocellular carcinoma. HPB (Oxf). 2009;11(4):351–7.

    Article  Google Scholar 

  26. Hsu KY, Chau GY, Lui WY, Tsay SH, King KL, Wu CW. Predicting morbidity and mortality after hepatic resection in patients with hepatocellular carcinoma: the role of Model for End-Stage Liver Disease score. World J Surg. 2009;33(11):2412–9.

    Article  PubMed  Google Scholar 

  27. Rahbari NN, Reissfelder C, Koch M, Elbers H, Striebel F, Buchler MW, et al. The predictive value of postoperative clinical risk scores for outcome after hepatic resection: a validation analysis in 807 patients. Ann Surg Oncol. 2011;18(13):3640–9.

    Article  PubMed  Google Scholar 

  28. Bruix J, Sherman M, American Association for the Study of Liver D. Management of hepatocellular carcinoma: an update. Hepatology. 2011;53(3):1020–2.

    Article  PubMed  PubMed Central  Google Scholar 

  29. European Association For The Study Of The L, European Organisation For R, Treatment Of C. EASL-EORTC. EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol. 2012;56(4):908–43.

    Article  Google Scholar 

  30. Cucchetti A, Ercolani G, Vivarelli M, Cescon M, Ravaioli M, Ramacciato G, et al. Is portal hypertension a contraindication to hepatic resection? Ann Surg. 2009;250(6):922–8.

    Article  PubMed  Google Scholar 

  31. Schroeder RA, Marroquin CE, Bute BP, Khuri S, Henderson WG, Kuo PC. Predictive indices of morbidity and mortality after liver resection. Ann Surg. 2006;243(3):373–9.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Teh SH, Sheppard BC, Schwartz J, Orloff SL. Model for End-stage Liver Disease score fails to predict perioperative outcome after hepatic resection for hepatocellular carcinoma in patients without cirrhosis. Am J Surg. 2008;195(5):697–701.

    Article  PubMed  Google Scholar 

  33. Cescon M, Cucchetti A, Grazi GL, Ferrero A, Vigano L, Ercolani G, et al. Indication of the extent of hepatectomy for hepatocellular carcinoma on cirrhosis by a simple algorithm based on preoperative variables. Arch Surg. 2009;144(1):57–63; discussion.

    Article  PubMed  Google Scholar 

  34. Causey MW, Nelson D, Johnson EK, Maykel J, Davis B, Rivadeneira DE, et al. The impact of Model for End-Stage Liver Disease-Na in predicting morbidity and mortality following elective colon cancer surgery irrespective of underlying liver disease. Am J Surg. 2014;207(4):520–6.

    Article  PubMed  Google Scholar 

  35. Greco E, Nanji S, Bromberg IL, Shah S, Wei AC, Moulton CA, et al. Predictors of peri-opertative morbidity and liver dysfunction after hepatic resection in patients with chronic liver disease. HPB (OXf). 2011;13(8):559–65.

    Article  Google Scholar 

  36. Gupta S, Chawla Y, Kaur J, Saxena R, Duseja A, Dhiman RK, et al. Indocyanine green clearance test (using spectrophotometry) and its correlation with model for end stage liver disease (MELD) score in Indian patients with cirrhosis of liver. Trop Gastroenterol. 2012;33(2):129–34.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Multi-Organ Transplant Institute, Department of Surgery, Ochsner Medical Center, 1514 Jefferson Highway, New Orleans, LA, 70121, USA

    Trevor W. Reichman & Humberto Bohorquez

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  1. Trevor W. Reichman
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  2. Humberto Bohorquez
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Correspondence to Trevor W. Reichman .

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Editors and Affiliations

  1. The University of Chicago, CHICAGO, Illinois, USA

    J. Michael Millis

  2. The University of Chicago, CHICAGO, Illinois, USA

    Jeffrey B. Matthews

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Reichman, T.W., Bohorquez, H. (2016). Which Is the Better Predictor of Hepatic Reserve Prior to Liver Resection: MELD or the Child-Pugh Score?. In: Millis, J., Matthews, J. (eds) Difficult Decisions in Hepatobiliary and Pancreatic Surgery. Difficult Decisions in Surgery: An Evidence-Based Approach. Springer, Cham. https://doi.org/10.1007/978-3-319-27365-5_16

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  • DOI: https://doi.org/10.1007/978-3-319-27365-5_16

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-27363-1

  • Online ISBN: 978-3-319-27365-5

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