title: Adding Liver Stiffness Measurement to the Routine Evaluation of Hepatocellular Carcinoma Resectability Can Optimize Clinical Outcome.
abstract: PurposeLiver stiffness (LS) has been shown to be of use in chronic liver disease patients but its utility in surgical judgment still needs to be proven. A decision-making approach was applied to evaluate whether LS measurement before surgery of hepatocellular carcinoma (HCC) can be useful in avoiding post-hepatectomy liver failure (PHLF).Materials and MethodsDecision curve analysis (DCA) was applied to 202 HCC patients (2008 - 14) with LS measurement prior to hepatectomy to verify whether the occurrence of PHLF grades B/C should be reduced through a decision-making approach with LS.ResultsWithin 90 days of surgery, 4 patients died (2 %) and grades B/C PHLF occurred in 29.7 % of cases. Ascites and/or pleural effusion, treatable with medical therapy, were the most frequent complications. DCA showed that using the "expected utility theory" LS measurement can reduce up to 39 % of cases of PHLF without the exclusion of any patient from surgery that duly undergoes an uncomplicated postoperative course. LS measurement does not add any information to normal clinical judgment for patients with a low (< 10 %) risk of PHLF.ConclusionLS measurement can determine a reduction of PHLF under "expected utility theory" fulfilment. However, the degree of PHLF can be minor and "risk seeking" individuals can accept such a risk on the basis of surgical benefits.
authors.affiliation: Department of Medical and Surgical Sciences - DIMEC; Alma Mater Studiorum - University of Bologna, S.Orsola - Malpighi Hospital, Bologna, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Cucchetti
authors.affiliation: Department of Medical and Surgical Sciences - DIMEC; Alma Mater Studiorum - University of Bologna, S.Orsola - Malpighi Hospital, Bologna, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Cescon
authors.affiliation: Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, Alma Mater Studiorum - University of Bologna, Gastroenterology Unit; S. Orsola - Malpighi Hospital, Bologna, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Colecchia
authors.affiliation: Department of Medical and Surgical Sciences - DIMEC; Alma Mater Studiorum - University of Bologna, S.Orsola - Malpighi Hospital, Bologna, Italy.
authors.forename: Flavia
authors.initials: F
authors.lastname: Neri
authors.affiliation: Department of Medical and Surgical Sciences - DIMEC; Alma Mater Studiorum - University of Bologna, Radiology Unit; S.Orsola - Malpighi Hospital, Bologna, Italy.
authors.forename: Alberta
authors.initials: A
authors.lastname: Cappelli
authors.affiliation: Department of Medical and Surgical Sciences - DIMEC; Alma Mater Studiorum - University of Bologna, S.Orsola - Malpighi Hospital, Bologna, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Ravaioli
authors.affiliation: Department of Medical and Surgical Sciences - DIMEC; Alma Mater Studiorum - University of Bologna, S.Orsola - Malpighi Hospital, Bologna, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Mazzotti
authors.affiliation: Department of Medical and Surgical Sciences - DIMEC; Alma Mater Studiorum - University of Bologna, S.Orsola - Malpighi Hospital, Bologna, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Ercolani
authors.affiliation: Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, Alma Mater Studiorum - University of Bologna, Gastroenterology Unit; S. Orsola - Malpighi Hospital, Bologna, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Festi
authors.affiliation: Department of Medical and Surgical Sciences - DIMEC; Alma Mater Studiorum - University of Bologna, S.Orsola - Malpighi Hospital, Bologna, Italy.
authors.forename: Antonio Daniele
authors.initials: AD
authors.lastname: Pinna
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000601:surgery; D054459:Elasticity Imaging Techniques; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery; D011183:Postoperative Complications