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Model for End-stage Liver Disease score fails to predict perioperative outcome after hepatic resection for hepatocellular carcinoma in patients without cirrhosis.
Am J Surg. 2008 May; 195(5):697-701.AJ

Abstract

BACKGROUND

The Model for End-stage Liver Disease (MELD) score was developed to reflect the hepatocellular reserve in patients with cirrhosis. We hypothesized that the MELD score would not be predictive of perioperative outcome after hepatic resection in patients without cirrhosis.

METHODS

We performed a case-control study of all consecutive patients from 1995 through 2005 undergoing hepatic resection for HCC.

RESULTS

Group A (21 patients without cirrhosis) had a mean age of 57 years, which was similar to control group B (25 patients with cirrhosis), with a mean age of 60 years. The mean tumor size in group A was 9.8 cm compared with that of group B, which was 4.8 cm (P = .03). The American Joint Committee on Cancer stage in group A was I in 14%, II in 5%, and III in 81% versus I in 48%, II in 16%, and 111 in 36% in group B (P = .002). Eighty-six percent of group A patients had a major hepatic resection (>2 segments) compared with 40% in group B (P = .001). The perioperative morbidity and mortality were 24% and 4.8%, respectively, in group A compared with 64% (P = .006) and 20% (P = .12) in group B. The mean preoperative, postoperative, and delta MELD scores were 7.0, 13.0, and 5.0, respectively, in group A compared with 9.6, 16.8, and 7.2 in group B (P = NS). In group A, none of the MELD score parameters accurately predicted perioperative outcomes despite a higher number of patients who had major hepatic resection. In group B, a preoperative MELD score of 9 or greater was associated with a higher overall perioperative morbidity (84% vs 41%, P = .03). Perioperative mortality (n = 6; 13%) was significantly higher in patients with a postoperative MELD score of 15 or higher (P = .02) and a delta MELD score of 10 or higher (P = .03).

CONCLUSIONS

Perioperative MELD score fails to predict perioperative outcomes after hepatic resection for hepatocellular carcinoma in patients without cirrhosis. Other predictive parameters need to be developed for this group of patients.

Authors+Show Affiliations

Division of General Surgery, Oregon Health and Science University, Portland, OR, USA. swee.teh@gmail.comNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Evaluation Study
Journal Article

Language

eng

PubMed ID

18367132

Citation

Teh, Swee H., et al. "Model for End-stage Liver Disease Score Fails to Predict Perioperative Outcome After Hepatic Resection for Hepatocellular Carcinoma in Patients Without Cirrhosis." American Journal of Surgery, vol. 195, no. 5, 2008, pp. 697-701.
Teh SH, Sheppard BC, Schwartz J, et al. Model for End-stage Liver Disease score fails to predict perioperative outcome after hepatic resection for hepatocellular carcinoma in patients without cirrhosis. Am J Surg. 2008;195(5):697-701.
Teh, S. H., Sheppard, B. C., Schwartz, J., & Orloff, S. L. (2008). Model for End-stage Liver Disease score fails to predict perioperative outcome after hepatic resection for hepatocellular carcinoma in patients without cirrhosis. American Journal of Surgery, 195(5), 697-701. https://doi.org/10.1016/j.amjsurg.2007.05.054
Teh SH, et al. Model for End-stage Liver Disease Score Fails to Predict Perioperative Outcome After Hepatic Resection for Hepatocellular Carcinoma in Patients Without Cirrhosis. Am J Surg. 2008;195(5):697-701. PubMed PMID: 18367132.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Model for End-stage Liver Disease score fails to predict perioperative outcome after hepatic resection for hepatocellular carcinoma in patients without cirrhosis. AU - Teh,Swee H, AU - Sheppard,Brett C, AU - Schwartz,Jonathan, AU - Orloff,Susan L, PY - 2007/04/27/received PY - 2007/05/29/revised PY - 2007/05/29/accepted PY - 2008/3/28/pubmed PY - 2008/5/28/medline PY - 2008/3/28/entrez SP - 697 EP - 701 JF - American journal of surgery JO - Am. J. Surg. VL - 195 IS - 5 N2 - BACKGROUND: The Model for End-stage Liver Disease (MELD) score was developed to reflect the hepatocellular reserve in patients with cirrhosis. We hypothesized that the MELD score would not be predictive of perioperative outcome after hepatic resection in patients without cirrhosis. METHODS: We performed a case-control study of all consecutive patients from 1995 through 2005 undergoing hepatic resection for HCC. RESULTS: Group A (21 patients without cirrhosis) had a mean age of 57 years, which was similar to control group B (25 patients with cirrhosis), with a mean age of 60 years. The mean tumor size in group A was 9.8 cm compared with that of group B, which was 4.8 cm (P = .03). The American Joint Committee on Cancer stage in group A was I in 14%, II in 5%, and III in 81% versus I in 48%, II in 16%, and 111 in 36% in group B (P = .002). Eighty-six percent of group A patients had a major hepatic resection (>2 segments) compared with 40% in group B (P = .001). The perioperative morbidity and mortality were 24% and 4.8%, respectively, in group A compared with 64% (P = .006) and 20% (P = .12) in group B. The mean preoperative, postoperative, and delta MELD scores were 7.0, 13.0, and 5.0, respectively, in group A compared with 9.6, 16.8, and 7.2 in group B (P = NS). In group A, none of the MELD score parameters accurately predicted perioperative outcomes despite a higher number of patients who had major hepatic resection. In group B, a preoperative MELD score of 9 or greater was associated with a higher overall perioperative morbidity (84% vs 41%, P = .03). Perioperative mortality (n = 6; 13%) was significantly higher in patients with a postoperative MELD score of 15 or higher (P = .02) and a delta MELD score of 10 or higher (P = .03). CONCLUSIONS: Perioperative MELD score fails to predict perioperative outcomes after hepatic resection for hepatocellular carcinoma in patients without cirrhosis. Other predictive parameters need to be developed for this group of patients. SN - 1879-1883 UR - https://www.unboundmedicine.com/medline/citation/18367132/Model_for_End_stage_Liver_Disease_score_fails_to_predict_perioperative_outcome_after_hepatic_resection_for_hepatocellular_carcinoma_in_patients_without_cirrhosis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9610(08)00090-1 DB - PRIME DP - Unbound Medicine ER -