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Author Notes:

Correspondence: Shishir K. Maithel, MD, Winship Cancer Institute, Emory University, Department of Surgery, Division of Surgical Oncology, 1365C Clifton Road NE, Building C, 2nd Floor, Atlanta, GA 30322; Email: smaithe@emory.edu.

Authors' Contributions: Study conception and design: Maithel, Kneuertz, Kooby, Scoggins, Weber, and Staley.

Acquisition of data: Maithel, Kneuertz, Kooby, Scoggins, Weber, Martin, McMasters, Cho, Winslow, and Staley.

Analysis and interpretation of data: Maithel, Kneuertz, Kooby, Scoggins, Weber, Martin, McMasters, Cho, Winslow, Wood, and Staley.

Drafting of manuscript: Maithel and Kneuertz.

Critical revision: Maithel, Kneuertz, Kooby, Scoggins, Weber, Martin, McMasters, Cho, Winslow, Wood, and Staley.

Disclosures: There are no conflicts of interest to disclose.


Importance of Low Preoperative Platelet Count in Selecting Patients for Resection of Hepatocellular Carcinoma: A Multi-Institutional Analysis

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Journal Title:

Journal of The American College of Surgeons


Volume 212, Number 4


, Pages 638-650

Type of Work:

Article | Post-print: After Peer Review


Background: Low platelet count is a marker of portal hypertension but is not routinely included in the standard preoperative evaluation of patients with hepatocellular carcinoma (HCC) because it pertains to liver function (Child/model for end-stage liver disease [MELD] score) and tumor burden (Milan criteria). We hypothesized that low platelet count would be independently associated with increased perioperative morbidity and mortality after resection. Study Design: Patients treated with liver resection for HCC between January 2000 and January 2010 at 3 institutions were eligible. Preoperative platelet count, Child/MELD score, and tumor extent were recorded. Low preoperative platelet count (LPPC) was defined as <150 × 103/μL. Postoperative liver insufficiency (PLI) was defined as peak bilirubin >7 mg/dL or development of ascites. Univariate and multivariate regression was performed for predictors of major complications, PLI, and 60-day mortality. Results: A total of 231 patients underwent resection, of whom 196 (85%) were classified as Child A and 35 (15%) as Child B; median MELD score was 8. Overall, 168 (71%) had tumors that exceeded Milan criteria and 134 (58%) had major hepatectomy (≥3 Couinaud segments). Overall and major complication rates were 55% and 17%, respectively. PLI occurred in 25 patients (11%), and 21 (9%) died within 60 days of surgery. Patients with LPPC (n = 50) had a significantly increased number of major complications (28% versus 14%, p = 0.031), PLI (30% versus 6%, p = 0.001), and 60-day mortality (22% versus 6%, p = 0.001). When adjusted for Child/MELD score and tumor burden, LPPC remained independently associated with increased number of major complications (odds ratio [OR] 2.8, 95% confidence intervals [CI] 1.1 to 6.8, p = 0.026), PLI (OR 4.0, 95% CI 1.4 to 11.1, p = 0.008), and 60-day mortality (OR 4.6, 95% CI 1.5 to 14.6, p = 0.009). Conclusions: LPPC is independently associated with increased major complications, PLI, and mortality after resection of HCC, even when accounting for standard criteria, such as Child/MELD score and tumor extent, used to select patients for resection. Patients with LPPC may be better served with transplantation or liver-directed therapy.

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© 2011 by the American College of Surgeons

This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommerical-NoDerivs 3.0 Unported License (http://creativecommons.org/licenses/by-nc-nd/3.0/).

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