الفهرس 
Liver cirrhosisOnly 14 pages are availabe for public view
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Abstract
Surgical resection for hepatocellular carcinoma is the standered
effective treatment .Partial hepatectomy or total hepatectomy with liver
transplantation are the only treatment options which have the potential to
cure.
Patients with liver cirrhosis are known to be at high risk of morbidity
and mortality following abdominal surgery. Liver resection for HCC
in a cirrhotic liver is contraindicated in the presence of severe
liver functional impairment. In these cases there is increased risk
of liver decompensation or failure during the postoperative period .
Hepatic failure following hepatectomy carries a dismal prognosis.
Inadequate reserve compromises liver function, the ability of the
liver to regenerate and results in liver failure .
Assessment of liver function is a critically important tool for selecting
patients for hepatic surgery. Not only is it important in the assessment of
a patient’s ability to withstand resection, it also has clearly played a role
in the selection process that surgeons apply to individual patients in
tailoring the appropriate extent of resection.
Staging systems are used to define prognosis and treatment
options. Several staging or scoring systems for HCC have been proposed
The aim of this work is to compare between MELD, Child Pugh and
Barcelona Clinic Liver Cancer scoring systems for pre-operative
assessment in cirrhotic patients prior to liver resection for hepatocellular
carcinoma
We retrospectively analyzed the collected data of forty cirrhotic
patients for whom surgical liver resection was performed as a treatment
modality for hepatocellular carcinoma in the National Liver Institute
Menoufiya University between January 2005 and June 2008. They were
10 females and 30 males.
In all patients, the clinical parameters, hematologic, biochemical, and
radiologic findings were obtained from the case records. The extent and
severity of the disease were evaluated by biochemical tests, instrumental
examination including hepatic ultrasonography, abdominal spiral CTscan,
and upper gastrointestinal endoscopy .
Data specific to individual staging systems were collected for
classifications of the patients within the three staging systems (Child
Pugh, MELD and Barcelona).
Postoperative mortality and morbidity especially postresectional liver
failure (PLF), postoperative ascites together with hospital and Intensive
Care Unit (ICU) stays were the points used to assess the performance of
the different scoring systems.
The patients were 30 males (75%) and 10 females (25%). Their age
ranged between 39 and 72 years with a mean age of 54.45+8.67.
For the Child Pugh scoring system thirty two patients were assigned
into class A (80% of the population) while eight patients fit into class B
(20%) . For Barcelona Clinic Liver Cancer the distribution of the patients
was twenty six patients fall into class A (65%), and fourteen patients
(35%) fall in class B. Finally MELD score was computed for each
patient, and the patients were divided into two groups; the first group
includes patients with score below 9 and the other group includes those
with score of 9 points or more
Non anatomical resection was performed for twenty nine patients
(72.5%) and anatomical resection performed for eight patients (20%)
while combination therapy performed in three patients (7.5%)
The three scoring systems were all good in discriminating patients
into different categories and into clinically distinct subgroups with
different outcomes depending on significant variables.
No mortality occurred among the forty patients during the period
from admission to the date of discharge and within 30 days after surgery,
and the complications ranged from transient impairment of liver function
in thirty patients, eight patients developed post resectional liver failure,
one patient had burst abdomen and one patient had bile leak.
Class A patients in BCLC scoring system was the least group that
developed PLF complication compared with similar patients in the other
scores. Only 11.5% of class A BCLC patients developed PLF compared
to 21.9% and 16.7% in Child PughA and MELD <9scores respectively.
Also Patients belonged to class A in BCLC showed shorter ICU
period than those in class B and shorter than those in the corresponding
subgroups in Child Pugh and MELD scores. The mean duration of
intensive care unit stay was about 2 days in BCLC while it was 4 days in
the other scores.
To compare between the 3 scoring systems in predicting PLF,
sensitivity, specificity, were calculated. Receiver operating characteristic
(ROC) curves were used to determine the cut off values for each system
and BCLC staging system showed more sensitivity , more specificity and
more accuracy than the other two scores.
BCLC A patients were the least group to develop post resection
ascites among the 3 scores and showed more sensitivity but Child Pugh
score was more specific in this regard.
We found that BCLC class A patients gives the best performance with
higher sensitivity and specificity among the three scores regarding
hospital stay.
Finally we found that the discriminatory ability and predictive
accuracy of BCLC were superior to what was measured with the Child
Pugh and MELD scores. It was more accurate in prediction of
complications and in linking between its occurrence and patient class and
to stratify patients according to expected outcome, accordingly, we
recommend that the BCLC strategy should be seen as a tool to manage
patients referred because of liver cancer detection.