Published online Aug 21, 2015. doi: 10.3748/wjg.v21.i31.9394
Peer-review started: November 2, 2014
First decision: December 2, 2014
Revised: March 11, 2015
Accepted: April 17, 2015
Article in press: April 17, 2015
Published online: August 21, 2015
AIM: To evaluate a different decision tree for safe liver resection and verify its efficiency.
METHODS: A total of 2457 patients underwent hepatic resection between January 2004 and December 2010 at the Chinese PLA General Hospital, and 634 hepatocellular carcinoma (HCC) patients were eligible for the final analyses. Post-hepatectomy liver failure (PHLF) was identified by the association of prothrombin time < 50% and serum bilirubin > 50 μmol/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 Chinese 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 Chinese 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 Chinese 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.
Core tip: We have established a decision tree for safe hepatectomy based on four variables: normal or cirrhotic liver, Child-Turcotte-Pugh score, the indocyanine green retention rate at 15 min, and the ratio of reserved functional liver volume to standard liver volume. Post-hepatectomy liver failure (PHLF) has been identified by the “50-50” criteria. The Chinese consensus decision tree expands the indications for hepatic resection for liver tumor and does not increase the PHLF rate compared to the Swiss-Clavien and Tokyo University-Makuuchi decision trees. The Chinese consensus decision tree would be a safe and effective algorithm for hepatectomy in patients with liver tumor.