Liver Decompensation Risk after Hepatectomy for Hepatocellular Carcinoma (HCC)

Clinically significant portal hypertension (varices, splenomegaly with platelets <100x10^9/L, or HVPG >=10 mmHg)

Extent of resection

MELD score

points

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When to use

Weighing resection against non-surgical options for HCC, and for informed-consent discussions about the risk of postoperative liver decompensation.

Formula

Hierarchical model: portal hypertension present + major resection = high risk (~60%); any other combination of (no portal hypertension + major resection), (portal hypertension + minor resection), or (MELD >9 with no portal hypertension and minor resection) = intermediate risk (~29%); no portal hypertension + minor resection + MELD <=9 = low risk (~5%).

Pearls and pitfalls

Clinically significant portal hypertension was the single strongest driver of decompensation risk in the derivation cohort, ahead of extent of resection and MELD score.
Should be integrated with overall clinical assessment (e.g. remnant liver volume, comorbidities) rather than used as the sole determinant of resectability.

References

Citterio D, Facciorusso A, Sposito C, et al. Hierarchic interaction of factors associated with liver decompensation after resection for hepatocellular carcinoma. JAMA Surg. 2016;151(9):846-853.