Hepatic insufficiency and mortality in 1,059 noncirrhotic patients undergoing major hepatectomy
Abstract
Background To establish a reliable definition of postoperative hepatic insufficiency (PHI) in noncirrhotic patients undergoing major hepatectomy. No standard definition of PHI has been established, but one is essential for meaningful comparison of outcomes data across studies. Methods Data from 1,059 noncirrhotic patients who underwent major hepatectomy (3 or more liver segments) at 3 centers from 1995 to 2005 were analyzed. Receiver operating characteristics (ROC) analysis of peak postoperative bilirubin ((Peak)Bil) and international normalized ratio ((Peak)INR) were used to define PHI. Results A total of 669 patients (63%) underwent resection of 3 to 4 liver segments; 390 (37%) underwent resection of 5 or more segments. Complications occurred in 453 (43%). The 90-day all-cause mortality rate was 4.7%, which is 47% higher than the 30-day rate (3.2%). Twenty (1.9%) patients died of causes unrelated to the liver. Of the remaining 1,039 patients, 30 (2.8%) died a median 36 days from liver-related causes (liver failure with or without multiorgan failure). ROC analysis revealed cut-offs that predict liver-related death are (Peak)Bil 7.0 mg/dL (area under the curve 0.982; sensitivity 93.3%; specificity 94.3%) and (Peak)INR 2.0 (area under the curve 0.846; sensitivity 76.7%; specificity 82.0%). (Peak)Bil > 7.0 mg/dL was the most powerful predictor of any (odds ratio [OR] = 83.3) or major complication (OR = 10.0), 90-day mortality (OR = 10.8), and 90-day liver-related mortality (OR…
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PHLF may lead to subsequent complications such as infection, bleeding, and kidney failure.
“This is crucial as PHLF may lead to subsequent complications such as infection, bleeding, and kidney failure [10,13,14].”
From The Role of Perioperative Interleukin-6 Serum Levels on Liver Dysfunction and Infectious Complications After Hepatectomy—A Systematic Review (2025) · cites this paper as [10]
Among several definitions for PHLF, the International Study Group of Liver Surgery criteria are most accepted, based on bilirubin and prothrombin time outside normal ranges on postoperative day 5 or later.
“Amongst several definitions for PHLF the International Study Group of Liver Surgery (ISGLS) criteria are most accepted (see Refs. [6,9,10]) based on bilirubin and prothrombin time outside normal ranges on postoperative day 5 or later.”
From The Role of Perioperative Interleukin-6 Serum Levels on Liver Dysfunction and Infectious Complications After Hepatectomy—A Systematic Review (2025) · cites this paper as [10]
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“This is crucial as PHLF may lead to subsequent complications such as infection, bleeding, and kidney failure [10,13,14].”
- Authors
- Mullen, J. T., Ribero, D., Reddy, S. K., Donadon, M., Zorzi, D., Gautam, S., Abdalla, E. K., Curley, S. A., Capussotti, L., Clary, B. M., & Vauthey, J.-N.
- Affiliations
- The University of Texas MD Anderson Cancer Center (US)
- Duke Medical Center (US)
- Beth Israel Deaconess Medical Center (US)
- Candiolo Cancer Institute (IT)
- Corresponding author
- Mullen, John T.
- Ribero, Dario
- Donadon, Matteo
- Zorzi, Daria
- Abdalla, Eddie K.
- Curley, Steven A.
- Vauthey, Jean-Nicolas
- Venue
- Journal of the American College of Surgeons
- Published
- 2007-05
- Volume
- 204
- Issue
- 5
- Pages
- 854-862
- ISSN
- 1072-7515 (ISSN-L)
- OpenAlex
- W1986014186
- Cited by
- 660
- References
- 0
- Citations by year
- 2026: 26 · 2025: 25 · 2024: 42 · 2023: 41 · 2022: 40 · 2021: 38 · 2020: 41 · 2019: 39 · 2018: 48 · 2017: 45 · 2016: 31 · 2015: 55 · 2014: 40 · 2013: 33 · 2012: 38
- FWCI
- 11.80
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of the American College of Surgeons (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Hepatology › Hepatocellular Carcinoma Treatment and Prognosis
- Health Sciences › Medicine › Surgery › Organ Transplantation Techniques and Outcomes
- Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
- Keywords
- major hepatectomy, non-cirrhotic patients, postoperative liver failure, liver-related mortality, international normalized ratio, postoperative complications, 90-day mortality, outcome prediction, standardized outcome reporting, multiple organ failure
- MeSH terms
- Adult, Bilirubin, Female, Hepatectomy, Humans, Liver Diseases, Male, Postoperative Complications, Predictive Value of Tests, ROC Curve, Sensitivity and Specificity, Logistic Models, Statistics, Nonparametric, International Normalized Ratio, Hepatic Insufficiency
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