Actual incidence and long-term consequences of posthepatectomy liver failure after hepatectomy for colorectal liver metastases.
BACKGROUND
Posthepatectomy liver failure (PHLF) is a severe complication after hepatectomy for colorectal liver metastases. This study evaluated its actual incidence and its effects on short- and long-term overall survival (OS) in a specialized center.


METHODS
Between 2006 and 2008, 193 patients who underwent 232 hepatectomies (147 minor and 85 major) for colorectal liver metastasis were studied prospectively. Hepatectomy was performed if the remnant liver volume was >0.5% of body weight. Uni- and multivariate analyses on OS after all hepatectomies (n = 232) or major resection only (n = 85) were then performed on pre-, intra-, and postoperative (including pathological) data to determine the consequences of PHLF by comparison with those of other intra- and postoperative events.


RESULTS
The 3-month postoperative mortality rate was 0.8%. PHLF was observed in six patients (7%) after major hepatectomy and in one (0.6%) after minor hepatectomy. With a 25-month follow-up, the 2-year OS rate was 84%. Preoperatively, pulmonary metastasis was the only determinant of OS. Intra- and postoperatively, four factors were determinant of OS: PHLF (risk ratio [RR] = 3.84, P = .04), mental confusion (RR = 3.11, P = .006), fluid collection (RR = 2.9, P = .01) and transfusion (RR = 2.27, P = .009). After major hepatectomy, only PHLF (RR = 4.14, P = .01) and confusion (RR = 3.6, P = .02) were identified.


CONCLUSIONS
With improvements in postoperative management, PHLF was found to be less responsible for 3-month mortality but remains an event that exerts a major impact on 2-year survival.
AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif, France; Inserm, Unité 785, Villejuif, France; Université Paris-Sud, Villejuif, France. Electronic address: eric.vibert@pbr.aphp.fr.
Eric
E
Vibert
AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif, France; Université Paris-Sud, Villejuif, France.
Gabriella
G
Pittau
AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif, France.
Maximilliano
M
Gelli
AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif, France; Inserm, Unité 785, Villejuif, France; Université Paris-Sud, Villejuif, France.
Antonio Sa
AS
Cunha
ALFACT Innovation, Paris, France.
Laure
L
Jamot
AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif, France; Inserm, Unité 785, Villejuif, France; Université Paris-Sud, Villejuif, France.
Jamila
J
Faivre
AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif, France.
Carlos
C
Castro Benitez
AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif, France; Inserm, Unité 785, Villejuif, France; Université Paris-Sud, Villejuif, France.
Denis
D
Castaing
AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif, France; Université Paris-Sud, Villejuif, France.
René
R
Adam
D000368:Aged; D015179:Colorectal Neoplasms / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006498:Hepatectomy / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D008099:Liver / Q000473:pathology; D017093:Liver Failure / Q000209:etiology / Q000401:mortality*; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality*; D012189:Retrospective Studies