• Cécile Skrzypczyk, Stéphanie Truant, Alain Duhamel, Carole Langlois, Emmanuel Boleslawski, Dine Koriche, Mohamed Hebbar, François Fourrier, Philippe Mathurin, and François René Pruvot.
• Departments of *Digestive Surgery and Transplantation †Statistical Analysis ‡Medical Oncology §Critical Care Medicine ¶Hepato-Gastroenterology, CHU, Univ Nord de France, Lille, France.
• Ann. Surg.. 2014 Nov 1;260(5):865-70; discussion 870.

ObjectiveTo assess the relevance of the International Study Group of Liver Surgery (ISGLS) definition of posthepatectomy liver failure compared with 2 well-established criteria, 50-50 and PeakBili>7, as early predictors of posthepatectomy outcome.BackgroundThere is limited data on the postoperative use of ISGLS definition of posthepatectomy liver failure as early predictor of outcome.MethodsBetween 2007 and 2012, a total of 680 hepatectomies were analyzed from a prospective database. The value of each definition for prediction of 3-month major complications (Clavien III-V) and mortality was assessed either within 10 days of surgery or on postoperative day 5.ResultsThree-month major morbidity and mortality rates were 16.5% and 4.4%, respectively. Within 10 days, 79 patients fulfilled ISGLS definition compared with 24 for 50-50 and 44 for PeakBili>7 criteria. Sensitivities of ISGLS definition and 50-50 and PeakBili>7 criteria for prediction of major morbidity and mortality were 35.8, 17.4, 24.8% and 56.7, 36.7, 56.7%, respectively. Patients with no positive score had a risk of death or major complication below 5% and 15%, respectively. In patients with a positive score, the ISGLS definition was the least relevant to predict major complications and mortality (positive predictive values of 49.4% and 21.8% vs 79.2% and 47.8% for 50-50 and 61.4% and 40.5% for PeakBili>7 criteria). The relative risk of death was 6.9 (95% confidence interval, 3.1-15.4) if the ISGLS definition was evaluated on postoperative day 5 versus 21.1 (95% confidence interval, 7.7-57.7) for 50-50 and 21.7 (95% confidence interval, 7.4-63.3) for PeakBili>7 criteria.ConclusionsISGLS definition was less discriminatory than 50-50 and PeakBili>7 criteria in identifying patients at risk of posthepatectomy major complications or death.

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