title: Safe hepatectomy selection criteria for hepatocellular carcinoma patients: a validation of 336 consecutive hepatectomies. The BILCHE score.
abstract: BACKGROUND
  Selection criteria for hepatectomy for hepatocellular carcinoma (HCC) are object of debate. We presented our criteria for safe hepatectomy for HCC, and we compared the results with those obtainable using the most common scores for HCC.
  
  
  METHODS
  All patients submitted to hepatectomy for HCC based on the same criteria were reviewed from our prospectively maintained database. Such criteria included bilirubin (BIL), cholinesterases (CHE), ascites, esophageal varices, and residual liver volume.
  
  
  RESULTS
  A total of 336 patients were analyzed. One hundred fifteen patients (33 %) had thoracoabdominal approach, but only 39 (12 %) had major or extended resections. The median tumor number was 1 (range 1-33), while the median tumor size was 3.6 cm (range 1.1-28). Of those, 94 (29 %) had postoperative complications, of which 6 % were graded as major (Dindo III-IV). The 90-days mortality was 2 %. The MELD, APRI, and CPT scores were not found to be statistically significant for complications, while combining BIL and CHE we defined four classes of risk. The association of BIL >1 mg/dl (>17.1 µmol/l) and CHE ≤ 5,900 U/l was the best to detect complications (OR = 4.45; P = 0.007).
  
  
  CONCLUSIONS
  This study shows that our selection criteria that count mainly on two commonly available, and inexpensive parameters, BIL and CHE, lead to identify patients potentially at risk of postoperative complications after hepatic resection for HCC.
  
  
  BACKGROUND
  NCT02056041 ( http://www.clinicaltrials.gov).
authors.affiliation: Department of Hepatobiliary Surgery, Humanitas Research Hospital, University of Milan School of Medicine, Via Manzoni 56, 20089, Rozzano, Milan, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Donadon
authors.forename: Guido
authors.initials: G
authors.lastname: Costa
authors.forename: Matteo
authors.initials: M
authors.lastname: Cimino
authors.forename: Fabio
authors.initials: F
authors.lastname: Procopio
authors.forename: Daniele Del
authors.initials: DD
authors.lastname: Fabbro
authors.forename: Angela
authors.initials: A
authors.lastname: Palmisano
authors.forename: Guido
authors.initials: G
authors.lastname: Torzilli
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001201:Ascites / Q000209:etiology; D001663:Bilirubin; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D002802:Cholinesterases; D015331:Cohort Studies; D004932:Esophageal and Gastric Varices / Q000209:etiology; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011183:Postoperative Complications; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D002802:Cholinesterases; D001663:Bilirubin