Liver Decompensation Risk after Hepatectomy for Hepatocellular Carcinoma (HCC)

Liver Decompensation Risk after Hepatectomy

Portal Hypertension

Extent of Hepatectomy

MELD Score

Platelet Count

Score:–

–

Predicts risk of liver decompensation after hepatectomy for hepatocellular carcinoma (HCC).

Why Use

Provides an objective estimate of post-hepatectomy liver decompensation, a complication that strongly influences length of stay, perioperative mortality, and long-term survival.

When to Use

Employ during preoperative planning to stratify risk in adults with well-compensated cirrhosis being evaluated for partial hepatectomy for hepatocellular carcinoma (HCC).

Formula

Portal hypertension = at least F1 esophageal varices (i.e., small and straight) on endoscopy OR platelets <100,000/μL with splenomegaly (>12 cm diameter). Extension of hepatectomy: major resection = removal of ≥3 adjacent segments.

Pearls / Pitfalls

Derived from a single Italian tertiary center; external validation is limited. Derivation cohort was majority men (75.7%) with a median age of 68 years. Demonstrated good discrimination across risk classes (c-index 0.78).

Advice

Use results to weigh surgical versus non-surgical options for HCC and to facilitate informed-consent discussions. Integrate the results of this tool with a comprehensive clinical assessment and specialist input; it should not be the sole determinant of treatment strategy or preoperative risk evaluation.

More Information

Interpretation: Risk Group Liver Decompensation Rate Median Length of Stay Risk of Mortality due to Liver Failure Low 4.9% 7 days 4.4% Intermediate 28.6% 8 days 9.0% High 60.0% 11 days 25.0%