Integrating surgical complexity and nutritional parameters to enhance prediction of postoperative complications in liver resection

Tomoaki Hayakawa; Yoshikuni Kawaguchi; Kyoji Ito; Andrea Campisi; Francesco Ardito; Satoru Abe; Yujiro Nishisoka; Akinori Miyata; Akihiko Ichida; Nobuhisa Akamatsu; Junichi Kaneko; Felice Giuliante; Kiyoshi Hasegawa

doi:10.1016/j.surg.2024.08.021

Integrating surgical complexity and nutritional parameters to enhance prediction of postoperative complications in liver resection

Surgery. 2024 Sep 19:S0039-6060(24)00600-7. doi: 10.1016/j.surg.2024.08.021. Online ahead of print.

Affiliations

¹ Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
² Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. Electronic address: yokawaguchi-tky@umin.ac.jp.
³ Hepatobiliary Surgery Unit, Foundation and Teaching HospiSacred Hearttal IRCCS A. Gemelli, Catholic University of the Sacred Heart, Rome, Italy.
⁴ Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. Electronic address: hasegawa-2su@h.u-tokyo.ac.jp.

PMID: 39304447
DOI: 10.1016/j.surg.2024.08.021

Abstract

Background: In patients undergoing liver resection, postoperative complications remain high. We hypothesized that the incidence of postoperative complications after liver resection would be predicted well by liver resection complexity and nutritional status.

Methods: We retrospectively assessed patients undergoing liver resection at The University of Tokyo Hospital from 2011 to 2021. Liver resection procedures were categorized by surgical complexity using a 3-level complexity classification. Nutritional parameters (including cholinesterase and albumin levels) were evaluated together with well-known nutritional indexes, including the modified Glasgow Prognostic Score, prognostic nutritional index, platelet-to-lymphocyte ratio, neutrophil-to-lymphocyte ratio, and controlling nutritional status.

Results: Of 1,258 patients, 570 (44.5%) experienced postoperative complications, with 506 (39.9%) requiring treatment (Clavien-Dindo grade II or greater). Multivariate logistic regression model analyses showed that cholinesterase and albumin levels, complexity classification, and open approach were associated with postoperative complications. The cholinesterase-liver resection complexity/approach model (area under the curve, 0.634) performed significantly better in predicting complications than the prognostic nutritional index (area under the curve, 0.560; P < .001), modified Glasgow Prognostic Score (area under the curve, 0.557; P < .001), controlling nutritional status (area under the curve, 0.502; P < .001), platelet-to-lymphocyte ratio (area under the curve, 0.513; P < .001), and neutrophil-to-lymphocyte ratio scores (area under the curve, 0.515; P < .001). On the basis of the cholinesterase-liver resection complexity/approach model, estimated complications ranged from 9.6% to 53.4%, and patients with well-maintained cholinesterase levels were estimated to have a 5-15% lower probability of complications than patients with impaired cholinesterase levels. This finding was validated with an external Western cohort.

Conclusion: The cholinesterase-liver resection complexity/approach model better predicted postoperative complications than nutritional indicators alone and may be useful for selecting patients who may benefit from nutritional support.