Prediction of mortality rate after major hepatectomy in patients without cirrhosis.

OBJECTIVE To assess the ability of preoperative biological parameters to predict a fatal outcome after a major liver resection in patients without cirrhosis. DESIGN Retrospective descriptive cohort study. SETTING Department of Digestive Surgery and Transplantation, University of Strasbourg. PATIENTS From January 1, 2004, through December 31, 2007, 67 consecutive patients underwent resection of at least 4 contiguous liver segments. MAIN OUTCOME MEASURES Perioperative data were prospectively recorded, and predictors of postoperative mortality rate and liver failure were analyzed. RESULTS Five patients (7%) died after a mean (SD) of 32.4 (11.8) postoperative days. The overall morbidity was 73% (49 patients). Univariate analysis revealed that a preoperative alanine aminotransferase blood level greater than 40 U/L (to convert to microkatals per liter, multiply by 0.0167), a preoperative prothrombin ratio less than 70%, a preoperative Indocyanine green retention rate at 15 minutes of greater than 15%, preoperative biliary drainage, and performance of extrahepatic bile duct resection significantly predict the occurrence of in-hospital death. The number of preoperative biological parameters in each patient significantly increased the mortality rate. Indeed, the mortalities were 0%, 3%, and 67% in patients presenting with none, 1, and 2 or more risk factors, respectively. CONCLUSIONS This study shows that preoperative liver tests and function can predict postoperative fatal outcome in patients presenting with biliary carcinomas and requiring a major liver resection. On the basis of these preoperative biological parameters, a decision-making algorithm is provided.