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PEAKBIL >7 MG/DL CLASSIFICATION OF POST-HEPATECTOMY LIVER FAILURE IS A PREDICTOR OF POOR ONCOLOGIC OUTCOME IN PATIENTS UNDERGOING HEPATECTOMY FOR COLORECTAL LIVER METASTASES
Katharina Joechle*, Eduardo A. Vega, Claire Goumard, Masuyuki Okuno, Yun Shin Chun, Ching-Wei Tzeng, Jeffrey E. Lee, Jean-Nicolas Vauthey, Claudius Conrad
Surgical Oncology, MD Anderson Cancer Center, Houston, TX

Background: PeakBil >7 mg/dl definition has been demonstrated to accurately predict mortality from post-hepatectomy liver failure (PHLF) in patients undergoing hepatectomy. While PeakBil >7 mg/dl definition has been shown to predict short term outcome its role in prognosticating long term survival remains unclear. This study aims at investigating, whether PHLF itself impacts on survival in patients requiring portal vein embolization for curative intent resection for colorectal liver metastases.
Methods: Between 1999 and 2015, patients with colorectal liver metastases (CRLM) and portal vein embolization (PVE) who underwent hepatectomy at a single institution were evaluated retrospectively. Patients with extrahepatic disease were excluded from analyses. PHLF was defined according to the classification of ISGLS and the PeakBil >7 mg/dl definition. Overall survival (OS) was analyzed using log-rank statistic mortality and risk factors for OS were analyzed by cox regression analysis. 90 day mortality was excluded from OS analysis.
Results: The study included 175 patients. PHLF was observed in 68 (38.9%) patients according to the ISGLS classification, in 40 (22.9%) patients with B and C clinically relevant PHLF and in 14 (8%) patients according to the PeakBil >7 mg/dl definition. Patients with PeakBil >7 mg/dl had significantly worse OS compared to patients who did not develop PHLF (OS rate at 5-years 16.7% vs. 47.1% p=0.006) in contrast to ISGLS (p=0.160) and clinically relevant ISGLS (p=0.113) that did not show significance. In the multivariate analysis, PeakBil >7 mg/dl (hazard ratio (HR) 5.27, 95% CI 1.97-14.15, p=0.001), largest diameter of metastasis ≥30 mm (HR 1.92, 95% CI 1.17-3.15, p=0.01) and intraoperative blood transfusion (HR 1.86, 95% CI 1.06-3.27, p=0.03) had impact on overall survival.
Conclusion: Patients with PHLF according to the PeakBil >7 mg/dl definition are not only at risk for short term morbidity and mortality but poor overall survival. Further, PeakBil versus ISGLS definition is a superior prognosticator of long term outcome. Patients with PeakBil >7 mg/dl following curative intent resection for colorectal liver metastases comprise oncologically a high risk cohort that may warrant consideration for intensified follow up and adjuvant therapy.


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