Perioperative risk assessment for hepatocellular carcinoma by using the MELD score.
OBJECTIVE
The aim of this study was to evaluate the ability of Model for End-Stage Liver Disease (MELD) in predicting post hepatectomy outcome for hepatocellular carcinoma (HCC).


METHODS
Between 2001 and 2005, 94 cirrhotic patients with HCC underwent hepatectomy and were analyzed retrospectively. MELD score associated with postoperative mortality and morbidity, hospital stay, and 3-year survival.


RESULTS
Twenty-eight major and 66 minor resections were performed. Thirty-day mortality rate was 6.4%. MELD <or= 9 was associated with no perioperative mortality vs 15.3% when MELD > 9 (p = 0.01). Overall morbidity rate was 32%; 21% when MELD <or= 9 vs 42% when MELD > 9 (p = 0.01). Median hospital stay was 11 days (7 days, when MELD <or= 9 and 14 days when MELD > 9; p = 0.03). Three-year survival reached 48% (63% when MELD <or= 9; 30% when MELD > 9; p < 0.01). In multivariate analysis, MELD > 9 (p = 0.01), clinical tumor symptoms (p = 0.04), and American Society of Anesthesiologists score (p = 0.04) were independent predictors of perioperative mortality; MELD > 9 (p = 0.01), tumor size >5 cm (p = 0.01), presence of tumor symptoms (p = 0.02), high tumor grade (p = 0.01), and absence of tumor capsule (p = 0.01) were independent predictors of decreased long-term survival.


CONCLUSIONS
MELD score seems to predict outcome of cirrhotic patients with HCC after hepatectomy.
Delis
Spiros G
SG
Division of Liver and GI Transplantation, University of Miami Miller School of Medicine, Miami, FL 33136, USA. sgdelis55@yahoo.gr
Bakoyiannis
Andreas
A
Dervenis
Christos
C
Tassopoulos
Nikos
N
D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000601:surgery*; D005260:Female; D006498:Hepatectomy; D006801:Humans; D007902:Length of Stay; D008113:Liver Neoplasms / Q000401:mortality / Q000601:surgery*; D008297:Male; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D015996:Survival Rate