title: Prediction of mortality rate after major hepatectomy in patients without cirrhosis.
abstract: OBJECTIVE
  To assess the ability of preoperative biological parameters to predict a fatal outcome after a major liver resection in patients without cirrhosis.
  
  
  METHODS
  Retrospective descriptive cohort study.
  
  
  METHODS
  Department of Digestive Surgery and Transplantation, University of Strasbourg.
  
  
  METHODS
  From January 1, 2004, through December 31, 2007, 67 consecutive patients underwent resection of at least 4 contiguous liver segments.
  
  
  METHODS
  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.
authors.affiliation: Centre de Chirurgie Viscérale et de Transplantation, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, France.
authors.forename: Elie
authors.initials: E
authors.lastname: Oussoultzoglou
authors.forename: Daniel
authors.initials: D
authors.lastname: Jaeck
authors.forename: Pietro
authors.initials: P
authors.lastname: Addeo
authors.forename: Pascal
authors.initials: P
authors.lastname: Fuchshuber
authors.forename: Ettore
authors.initials: E
authors.lastname: Marzano
authors.forename: Edoardo
authors.initials: E
authors.lastname: Rosso
authors.forename: Patrick
authors.initials: P
authors.lastname: Pessaux
authors.forename: Philippe
authors.initials: P
authors.lastname: Bachellier
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D016009:Chi-Square Distribution; D003657:Decision Making; D005260:Female; D006498:Hepatectomy / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D008103:Liver Cirrhosis; D008107:Liver Diseases / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D008111:Liver Function Tests; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D018709:Statistics, Nonparametric; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome