The model of end-stage liver disease (MELD) score in predicting postoperative liver failure after hepatic resection of hepatocellular carcinoma in cirrhotic patients: The Tunisian experience

Abstract 

Background and study aims

Hepatocellular carcinoma (HCC) is one of the most frequent cancers in the world. Factors associated with prognosis following resection remain ill defined. The model for end-stage liver disease (MELD) is considered as an index of hepatic functional reserve.

This study evaluates the reliability of the MELD score in the prediction of liver failure after hepatic resection for HCC in cirrhotic patients.

Patients and methods

A retrospective chart review was undertaken of patients with HCC and cirrhosis undergoing hepatic resection between January 1991 and December 2007. A total of 26 cirrhotic patients underwent curative hepatic resection for HCC at our department.

Patient information included demographic features, American Society of Anesthesiologists (ASA) class, aetiology of cirrhosis, laboratory test results, type of surgical procedure, duration of hospitalisation, and Child–Turcotte–Pugh and MELD scores.

Results

Six patients (23.1%) developed postoperative liver failure. As much as 66.66% of liver failures were seen in patients who have had major hepatectomy.

Using receiver operating characteristic curve analysis, we identified that a MELD score equal to or above 9.5 is the best cut-off value for predicting postoperative liver failure.

Patients were divided in two groups: MELD below 9.5 (group A) and MELD equal to or above 9.5 (group B). The highest prevalence of postoperative liver failure of 83.33% was observed in group B.

MELD score ⩾9.5 and low serum sodium are strongly predictive of increased postoperative liver failure in patients with cirrhosis undergoing hepatic resection for HCC.

Conclusion

The presence of liver cirrhosis is an important factor that affects the prognosis of patients with hepatocellular carcinoma (HCC). Cirrhotic patients with a high MELD score are at high risk of postoperative liver failure and complications and should be referred for non-surgical treatment.

Abbreviations: CTP, Child–Turcotte–Pugh, INR, international normalised ratio, MELD, model for end-stage liver disease, HCC, hepatocellular carcinoma, ASA, American Society of Anesthesiologists

Keywords: Hepatocellular carcinoma, Prognosis, End-stage liver disease model score, Postoperative, Liver failure