Meta-analysis of risk factors for posthepatectomy liver failure in patients with hepatocellular carcinoma

Objective To investigate the risk factors for posthepatectomy liver failure ( PHLF) in patients with hepatocellular carcinoma ( HCC) and to provide a theoretical basis for the prediction and prevention of PHLF. Methods A meta-analysis was performed on the studies on risk factors for PHLF in HCC patients published in China from January 1990 to June 2013 by searching SinoMed, VIP, CNKI, and Wanfang Data and manual retrieval of related articles and references. Results A total of 11 studies involving 2859 patients treated with hepatectomy were included in the meta-analysis. The incidence of PHLF was significantly lower in Child-Pugh A patients than in the control group ( pooled OR = 6. 28, 95% CI: 4. 55-8. 65) . Patients with prealbumin levels less than 170 mg /dl had an increased incidence of PHLF ( pooled OR = 4. 96, 95% CI: 3. 03-8. 10) . Patients with cirrhosis had a higher incidence of PHLF than those without cirrhosis ( pooled OR = 4.14, 95%CI: 2.46-6.98) . Patients with an intraoperative blood loss less than 1000 ml had a lower incidence of PHLF than the control group ( pooled OR = 5. 62, 95% CI: 3. 46-9. 11) . The incidence of PHLF was lower in patients with a tumor diameter less than 10 cm and patients with an extent of resection less than hepatectomy than in the control group ( pooled OR = 2. 69, 95% CI: 1. 58-4. 57; pooled OR = 1. 64, 95% CI: 1. 12-2. 40) . Age ≥60 years and intraoperative blood transfusion increased the incidence of PHLF ( pooled OR = 1.73, 95% CI: 1.25-2.39; pooled OR = 3.79, 95% CI: 2.20-6.51) . Sex and hepatic inflow occlusion were not significantly associated with the development of PHLF ( P > 0. 05) Conclusion Advanced age, advanced preoperative Child-Pugh class, low prealbumin level, high intraoperative blood loss, large tumor diameter, large extent of hepatectomy, cirrhosis, and intraoperative blood transfusion are risk factors for the development of PHLF.