title: Assessment of ISGLS definition of posthepatectomy liver failure and its effect on outcome in patients with hepatocellular carcinoma.
abstract: BACKGROUND
  Posthepatectomy liver failure (PHLF) is a major complication after hepatectomy. As there was no standardized definition, the International Study Group of Liver Surgery (ISGLS) defined PHLF as increased international normalized ratio and hyperbilirubinemia on or after postoperative day 5 in 2010. We evaluated the impact of the ISGLS definition of PHLF on hepatocellular carcinoma (HCC) patients.
  
  
  METHODS
  We retrospectively analyzed 210 consecutive HCC patients who underwent curative hepatectomy at our facility from 2005 to 2010. The median follow-up period after hepatectomy was 35.2 months.
  
  
  RESULTS
  Thirty-nine (18.6%) patients fulfilled the ISGLS definition of PHLF. Overall survival (OS) rates at 1, 3, and 5 years in patients with/without PHLF were 69.1/93.5, 45.1/72.5, and 45.1/57.8%, respectively (P = 0.002). Recurrence-free survival (RFS) rates at 1, 3, and 5 years in patients with/without PHLF were 40.9/65.9, 15.7/38.3, and 15.7/20.3%, respectively (P = 0.003). Multivariate analysis revealed that PHLF was significantly associated with both OS (P = 0.047) and RFS (P = 0.019). Extent of resection (P < 0.001), intraoperative blood loss (P = 0.002), and fibrosis stage (P = 0.040) were identified as independent risk factors for developing PHLF.
  
  
  CONCLUSIONS
  The ISGLS definition of PHLF was associated with OS and RFS in HCC patients, and long-term survival will be improved by reducing the incidence of PHLF.
authors.affiliation: Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Fukushima
authors.forename: Takumi
authors.initials: T
authors.lastname: Fukumoto
authors.forename: Kaori
authors.initials: K
authors.lastname: Kuramitsu
authors.forename: Masahiro
authors.initials: M
authors.lastname: Kido
authors.forename: Atsushi
authors.initials: A
authors.lastname: Takebe
authors.forename: Motofumi
authors.initials: M
authors.lastname: Tanaka
authors.forename: Tomoo
authors.initials: T
authors.lastname: Itoh
authors.forename: Yonson
authors.initials: Y
authors.lastname: Ku
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000009:adverse effects*; D017052:Hospital Mortality; D006801:Humans; D006932:Hyperbilirubinemia / Q000209:etiology; D019934:International Normalized Ratio; D007902:Length of Stay; D008103:Liver Cirrhosis / Q000150:complications / Q000473:pathology; D017093:Liver Failure / Q000145:classification* / Q000209:etiology*; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D009626:Terminology as Topic; D016896:Treatment Outcome