Safety validation of decision trees for hepatocellular carcinoma

AIM: To evaluate a different decision tree for safe liver resection and verify its efficiency.METHODS: A total of 2457 patients underwent hepatic resection between January 2004 and December 2010 at the Chinese PLA General Hospital,and 634 hepatocellular carcinoma(HCC) patients were eligible for the final analyses. Post-hepatectomy liver failure(PHLF) was identified by the association of prothrombin time < 50% and serum bilirubin > 50 μmol/L(the "50-50" criteria),which were assessed at day 5 postoperatively or later. The Swiss-Clavien decision tree,Tokyo University-Makuuchi decision tree,and Chinese consensus decision tree were adopted to divide patients into two groups based on those decision trees in sequence,and the PHLF rates were recorded.RESULTS: The overall mortality and PHLF rate were 0.16% and 3.0%. A total of 19 patients experienced PHLF. The numbers of patients to whom the SwissClavien,Tokyo University-Makuuchi,and Chinese consensus decision trees were applied were 581,573,and 622,and the PHLF rates were 2.75%,2.62%,and 2.73%,respectively. Significantly more cases satisfied the Chinese consensus decision tree than the Swiss-Clavien decision tree and Tokyo University-Makuuchi decision tree(P < 0.01,P < 0.01); nevertheless,the latter two shared no difference(P = 0.147). The PHLF rate exhibited no significant difference with respect to the three decision trees.CONCLUSION: The Chinese consensus decision tree expands the indications for hepatic resection for HCC patients and does not increase the PHLF rate compared to the Swiss-Clavien and Tokyo UniversityMakuuchi decision trees. It would be a safe and effective algorithm for hepatectomy in patients with hepatocellular carcinoma.