Decision tree for liver resection for hepatocellular carcinoma
Menée à partir de données portant sur 543 patients présentant une maladie chronique du foie et atteints d'un carcinome hépatocellulaire traité par résection entre 2000 et 2013 (âge médian : 68 ans ; 24,3 % de femmes), cette étude analyse les interactions entre les facteurs associés à une décompensation hépatique postopératoire, puis hiérarchise ces interactions
The incidence of hepatocellular carcinoma in the United States has grown steadily during the past 2 decades and the associated mortality has increased proportionally.1 In 2012, there were an estimated 30 000 new cases of liver cancer and 24 000 liver cancer–associated deaths.2 Underlying liver disease associated with hepatitis, autoimmune disorders, alcoholic cirrhosis, or nonalcoholic fatty liver disease has become the major risk factor for hepatocellular carcinoma in the United States.3 In fact, liver dysfunction in some form is found in upwards of 90% of patients who present with hepatocellular carcinoma.4 In these patients, curative resection is often challenging because underlying liver disease may render the functional liver remnant inadequate. An inadequate functional liver remnant can lead to the most dreaded complication following liver resection, posthepatectomy liver decompensation (LD). Given the morbidity and mortality associated with LD, appropriate preoperative risk prediction and stratification are paramount.5,6
JAMA Surgery , résumé, 2015