Cancers (Dec 2020)
Performance of Comprehensive Complication Index and Clavien-Dindo Complication Scoring System in Liver Surgery for Hepatocellular Carcinoma
- Alessandro Giani,
- Federica Cipriani,
- Simone Famularo,
- Matteo Donadon,
- Davide Paolo Bernasconi,
- Francesco Ardito,
- Federico Fazio,
- Daniele Nicolini,
- Pasquale Perri,
- Mario Giuffrida,
- Nicholas Pontarolo,
- Matteo Zanello,
- Quirino Lai,
- Simone Conci,
- Sarah Molfino,
- Paola Germani,
- Enrico Pinotti,
- Maurizio Romano,
- Giuliano La Barba,
- Cecilia Ferrari,
- Stefan Patauner,
- Alberto Manzoni,
- Ivano Sciannamea,
- Luca Fumagalli,
- Albert Troci,
- Valentina Ferraro,
- Antonio Floridi,
- Fabrizio Romano,
- Cristina Ciulli,
- Marco Braga,
- Francesca Ratti,
- Guido Costa,
- Francesco Razionale,
- Nadia Russolillo,
- Laura Marinelli,
- Valerio De Peppo,
- Elena Cremaschi,
- Francesco Calabrese,
- Zoe Larghi Laureiro,
- Giovanni Lazzari,
- Davide Cosola,
- Mauro Montuori,
- Luca Salvador,
- Alessandro Cucchetti,
- Angelo Franceschi,
- Michele Ciola,
- Valentina Sega,
- Pietro Calcagno,
- Luca Pennacchi,
- Michele Tedeschi,
- Riccardo Memeo,
- Michele Crespi,
- Marco Chiarelli,
- Adelmo Antonucci,
- Giuseppe Zimmitti,
- Antonio Frena,
- Andrea Percivale,
- Giorgio Ercolani,
- Giacomo Zanus,
- Mauro Zago,
- Paola Tarchi,
- Gian Luca Baiocchi,
- Andrea Ruzzenente,
- Massimo Rossi,
- Elio Jovine,
- Marcello Maestri,
- Raffaele Dalla Valle,
- Gian Luca Grazi,
- Marco Vivarelli,
- Alessandro Ferrero,
- Felice Giuliante,
- Guido Torzilli,
- Luca Aldrighetti,
- Luca Gianotti
Affiliations
- Alessandro Giani
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
- Federica Cipriani
- Hepatobiliary Surgery Division, Ospedale San Raffaele, 20132 Milan, Italy
- Simone Famularo
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
- Matteo Donadon
- Department of Hepatobiliary and General Surgery, Humanitas University, Humanitas Clinical and Research Center, Rozzano, 20089 Milan, Italy
- Davide Paolo Bernasconi
- Bicocca Bioinformatics Biostatistics and Bioimaging Centre-B4, School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
- Francesco Ardito
- Hepatobiliary Surgery Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Catholic University of the Sacred Heart, 00118 Rome, Italy
- Federico Fazio
- Department of General and Oncological Surgery, Mauriziano Hospital “Umberto I”, 10112 Turin, Italy
- Daniele Nicolini
- Hepatopancreatobiliary and Transplant Unit, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, 60121 Ancona, Italy
- Pasquale Perri
- Division of Hepatobiliarypancreatic surgery, IRCCS—Regina Elena National Cancer Institute, 00119 Rome, Italy
- Mario Giuffrida
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
- Nicholas Pontarolo
- Unit of General Surgery 1, University of Pavia and Foundation IRCCS Policlinico San Matteo, 27100 Pavia, Italy
- Matteo Zanello
- Department of Surgery, AOU Sant’Orsola Malpighi, IRCCS Azienda Ospedaliera Universitaria, 40141 Bologna, Italy
- Quirino Lai
- Hepatobiliary and Organ Transplantation Unit, Sapienza University of Rome, Umberto I Polyclinic of Rome, 00118 Rome, Italy
- Simone Conci
- Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37121 Verona, Italy
- Sarah Molfino
- Department of Clinical and Experimental Sciences, University of Brescia, 25136 Brescia, Italy
- Paola Germani
- Department of General Surgery, ASUGI, University Hospital of Trieste, 34121 Trieste, Italy
- Enrico Pinotti
- Department of Surgery, Ponte San Pietro Hospital, 24129 Bergamo, Italy
- Maurizio Romano
- Department of Surgical, Oncological and Gastroenterological Science (DISCOG), University of Padua; Hepatobiliary and Pancreatic Surgery Unit—Treviso Hospital, 31102 Treviso Italy
- Giuliano La Barba
- General and Oncologic Surgery, Morgagni-Pierantoni Hospital, 47122 Forlì, Italy
- Cecilia Ferrari
- HPB Surgical Unit, San Paolo Hospital, 17100 Savona, Italy
- Stefan Patauner
- Department of Surgery, Bolzano Central Hospital, 39100 Bolzano, Italy
- Alberto Manzoni
- Department of General Surgery, Poliambulanza Foundation Hospital, 25136 Brescia, Italy
- Ivano Sciannamea
- Department of Surgery, Monza Polyclinic, 20900 Monza, Italy
- Luca Fumagalli
- Department of Emergency and Robotic Surgery, ASST Lecco, 23900 Lecco, Italy
- Albert Troci
- Department of Surgery, L. Sacco Hospital, 20143 Milan, Italy
- Valentina Ferraro
- Department of Hepato-Pancreatic-Biliary Surgery, Miulli Hospital, 70132 Bari, Italy
- Antonio Floridi
- Department of General Surgery, ASST Crema, 26013 Crema, Italy
- Fabrizio Romano
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
- Cristina Ciulli
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
- Marco Braga
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
- Francesca Ratti
- Hepatobiliary Surgery Division, Ospedale San Raffaele, 20132 Milan, Italy
- Guido Costa
- Department of Hepatobiliary and General Surgery, Humanitas University, Humanitas Clinical and Research Center, Rozzano, 20089 Milan, Italy
- Francesco Razionale
- Hepatobiliary Surgery Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Catholic University of the Sacred Heart, 00118 Rome, Italy
- Nadia Russolillo
- Department of General and Oncological Surgery, Mauriziano Hospital “Umberto I”, 10112 Turin, Italy
- Laura Marinelli
- Hepatopancreatobiliary and Transplant Unit, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, 60121 Ancona, Italy
- Valerio De Peppo
- Division of Hepatobiliarypancreatic surgery, IRCCS—Regina Elena National Cancer Institute, 00119 Rome, Italy
- Elena Cremaschi
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
- Francesco Calabrese
- Unit of General Surgery 1, University of Pavia and Foundation IRCCS Policlinico San Matteo, 27100 Pavia, Italy
- Zoe Larghi Laureiro
- Hepatobiliary and Organ Transplantation Unit, Sapienza University of Rome, Umberto I Polyclinic of Rome, 00118 Rome, Italy
- Giovanni Lazzari
- Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37121 Verona, Italy
- Davide Cosola
- Department of General Surgery, ASUGI, University Hospital of Trieste, 34121 Trieste, Italy
- Mauro Montuori
- Department of Surgery, Ponte San Pietro Hospital, 24129 Bergamo, Italy
- Luca Salvador
- Department of Surgical, Oncological and Gastroenterological Science (DISCOG), University of Padua; Hepatobiliary and Pancreatic Surgery Unit—Treviso Hospital, 31102 Treviso Italy
- Alessandro Cucchetti
- General and Oncologic Surgery, Morgagni-Pierantoni Hospital, 47122 Forlì, Italy
- Angelo Franceschi
- HPB Surgical Unit, San Paolo Hospital, 17100 Savona, Italy
- Michele Ciola
- Department of Surgery, Bolzano Central Hospital, 39100 Bolzano, Italy
- Valentina Sega
- Department of General Surgery, Poliambulanza Foundation Hospital, 25136 Brescia, Italy
- Pietro Calcagno
- Department of Emergency and Robotic Surgery, ASST Lecco, 23900 Lecco, Italy
- Luca Pennacchi
- Department of Surgery, L. Sacco Hospital, 20143 Milan, Italy
- Michele Tedeschi
- Department of Hepato-Pancreatic-Biliary Surgery, Miulli Hospital, 70132 Bari, Italy
- Riccardo Memeo
- Department of Hepato-Pancreatic-Biliary Surgery, Miulli Hospital, 70132 Bari, Italy
- Michele Crespi
- Department of Surgery, L. Sacco Hospital, 20143 Milan, Italy
- Marco Chiarelli
- Department of Emergency and Robotic Surgery, ASST Lecco, 23900 Lecco, Italy
- Adelmo Antonucci
- Department of Surgery, Monza Polyclinic, 20900 Monza, Italy
- Giuseppe Zimmitti
- Department of General Surgery, Poliambulanza Foundation Hospital, 25136 Brescia, Italy
- Antonio Frena
- Department of Surgery, Bolzano Central Hospital, 39100 Bolzano, Italy
- Andrea Percivale
- HPB Surgical Unit, San Paolo Hospital, 17100 Savona, Italy
- Giorgio Ercolani
- General and Oncologic Surgery, Morgagni-Pierantoni Hospital, 47122 Forlì, Italy
- Giacomo Zanus
- Department of Surgical, Oncological and Gastroenterological Science (DISCOG), University of Padua; Hepatobiliary and Pancreatic Surgery Unit—Treviso Hospital, 31102 Treviso Italy
- Mauro Zago
- Department of Surgery, Ponte San Pietro Hospital, 24129 Bergamo, Italy
- Paola Tarchi
- Department of General Surgery, ASUGI, University Hospital of Trieste, 34121 Trieste, Italy
- Gian Luca Baiocchi
- Department of Clinical and Experimental Sciences, University of Brescia, 25136 Brescia, Italy
- Andrea Ruzzenente
- Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37121 Verona, Italy
- Massimo Rossi
- Hepatobiliary and Organ Transplantation Unit, Sapienza University of Rome, Umberto I Polyclinic of Rome, 00118 Rome, Italy
- Elio Jovine
- Department of Surgery, AOU Sant’Orsola Malpighi, IRCCS Azienda Ospedaliera Universitaria, 40141 Bologna, Italy
- Marcello Maestri
- Unit of General Surgery 1, University of Pavia and Foundation IRCCS Policlinico San Matteo, 27100 Pavia, Italy
- Raffaele Dalla Valle
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
- Gian Luca Grazi
- Division of Hepatobiliarypancreatic surgery, IRCCS—Regina Elena National Cancer Institute, 00119 Rome, Italy
- Marco Vivarelli
- Hepatopancreatobiliary and Transplant Unit, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, 60121 Ancona, Italy
- Alessandro Ferrero
- Department of General and Oncological Surgery, Mauriziano Hospital “Umberto I”, 10112 Turin, Italy
- Felice Giuliante
- Hepatobiliary Surgery Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Catholic University of the Sacred Heart, 00118 Rome, Italy
- Guido Torzilli
- Department of Hepatobiliary and General Surgery, Humanitas University, Humanitas Clinical and Research Center, Rozzano, 20089 Milan, Italy
- Luca Aldrighetti
- Hepatobiliary Surgery Division, Ospedale San Raffaele, 20132 Milan, Italy
- Luca Gianotti
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
- DOI
- https://doi.org/10.3390/cancers12123868
- Journal volume & issue
-
Vol. 12,
no. 12
p. 3868
Abstract
Background: We aimed to assess the ability of comprehensive complication index (CCI) and Clavien-Dindo complication (CDC) scale to predict excessive length of hospital stay (e-LOS) in patients undergoing liver resection for hepatocellular carcinoma. Methods: Patients were identified from an Italian multi-institutional database and randomly selected to be included in either a derivation or validation set. Multivariate logistic regression models and ROC curve analysis including either CCI or CDC as predictors of e-LOS were fitted to compare predictive performance. E-LOS was defined as a LOS longer than the 75th percentile among patients with at least one complication. Results: A total of 2669 patients were analyzed (1345 for derivation and 1324 for validation). The odds ratio (OR) was 5.590 (95%CI 4.201; 7.438) for CCI and 5.507 (4.152; 7.304) for CDC. The AUC was 0.964 for CCI and 0.893 for CDC in the derivation set and 0.962 vs. 0.890 in the validation set, respectively. In patients with at least two complications, the OR was 2.793 (1.896; 4.115) for CCI and 2.439 (1.666; 3.570) for CDC with an AUC of 0.850 and 0.673, respectively in the derivation cohort. The AUC was 0.806 for CCI and 0.658 for CDC in the validation set. Conclusions: When reporting postoperative morbidity in liver surgery, CCI is a preferable scale.
Keywords
- liver surgery
- hepatocellular carcinoma
- Clavien-Dindo classification
- comprehensive complication index
- performance
- length of stay
