Format

Send to

Choose Destination
Ultraschall Med. 2017 Oct;38(5):515-522. doi: 10.1055/s-0042-104648. Epub 2016 May 3.

Adding Liver Stiffness Measurement to the Routine Evaluation of Hepatocellular Carcinoma Resectability Can Optimize Clinical Outcome.

Author information

1
Department of Medical and Surgical Sciences - DIMEC; Alma Mater Studiorum - University of Bologna, S.Orsola - Malpighi Hospital, Bologna, Italy.
2
Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, Alma Mater Studiorum - University of Bologna, Gastroenterology Unit; S. Orsola - Malpighi Hospital, Bologna, Italy.
3
Department of Medical and Surgical Sciences - DIMEC; Alma Mater Studiorum - University of Bologna, Radiology Unit; S.Orsola - Malpighi Hospital, Bologna, Italy.

Abstract

in English, German

Purpose Liver stiffness (LS) has been shown to be of use in chronic liver disease patients but its utility in surgical judgment still needs to be proven. A decision-making approach was applied to evaluate whether LS measurement before surgery of hepatocellular carcinoma (HCC) can be useful in avoiding post-hepatectomy liver failure (PHLF). Materials and Methods Decision curve analysis (DCA) was applied to 202 HCC patients (2008 - 14) with LS measurement prior to hepatectomy to verify whether the occurrence of PHLF grades B/C should be reduced through a decision-making approach with LS.  Results Within 90 days of surgery, 4 patients died (2 %) and grades B/C PHLF occurred in 29.7 % of cases. Ascites and/or pleural effusion, treatable with medical therapy, were the most frequent complications. DCA showed that using the "expected utility theory" LS measurement can reduce up to 39 % of cases of PHLF without the exclusion of any patient from surgery that duly undergoes an uncomplicated postoperative course. LS measurement does not add any information to normal clinical judgment for patients with a low (< 10 %) risk of PHLF. Conclusion LS measurement can determine a reduction of PHLF under "expected utility theory" fulfilment. However, the degree of PHLF can be minor and "risk seeking" individuals can accept such a risk on the basis of surgical benefits.

PMID:
27139376
DOI:
10.1055/s-0042-104648

Conflict of interest statement

Financial support: This work was supported in part by the fund “Ricerca Fondamentale Orientata (ex 60 %)” of the University of Bologna, Italy.

Supplemental Content

Full text links

Icon for Georg Thieme Verlag Stuttgart, New York
Loading ...
Support Center