{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T17:31:48Z","timestamp":1791999108517,"version":"4.4.0"},"reference-count":57,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,5]]},"abstract":"<jats:sec>\n            <jats:title>Background:<\/jats:title>\n            <jats:p>Metabolic syndrome (MS) is rapidly growing as risk factor for HCC. Liver resection for HCC in patients with MS is associated with increased postoperative risks. There are no data on factors associated with postoperative complications.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Aims:<\/jats:title>\n            <jats:p>The aim was to identify risk factors and develop and validate a model for postoperative major morbidity after liver resection for HCC in patients with MS, using a large multicentric Western cohort.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Materials and Methods:<\/jats:title>\n            <jats:p>The univariable logistic regression analysis was applied to select predictive factors for 90 days major morbidity. The model was built on the multivariable regression and presented as a nomogram. Performance was evaluated by internal validation through the bootstrap method. The predictive discrimination was assessed through the concordance index.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>A total of 1087 patients were gathered from 24 centers between 2001 and 2021. Four hundred and eighty-four patients (45.2%) were obese. Most liver resections were performed using an open approach (59.1%), and 743 (68.3%) underwent minor hepatectomies. Three hundred and seventy-six patients (34.6%) developed postoperative complications, with 13.8% major morbidity and 2.9% mortality rates. Seven hundred and thirteen patients had complete data and were included in the prediction model. The model identified obesity, diabetes, ischemic heart disease, portal hypertension, open approach, major hepatectomy, and changes in the nontumoral parenchyma as risk factors for major morbidity. The model demonstrated an AUC of 72.8% (95% CI: 67.2%\u201378.2%) (https:\/\/childb.shinyapps.io\/NomogramMajorMorbidity90days\/).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>Patients undergoing liver resection for HCC and MS are at high risk of postoperative major complications and death. Careful patient selection, considering baseline characteristics, liver function, and type of surgery, is key to achieving optimal outcomes.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/hep.0000000000000027","type":"journal-article","created":{"date-parts":[[2023,1,16]],"date-time":"2023-01-16T23:00:30Z","timestamp":1673910030000},"page":"1527-1539","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":26,"title":["Model to predict major complications following liver resection for HCC in patients with metabolic syndrome"],"prefix":"10.1097","volume":"77","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8827-9189","authenticated-orcid":false,"given":"Giammauro","family":"Berardi","sequence":"first","affiliation":[{"name":"Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA"},{"name":"Department of Surgery, San Camillo Forlanini Hospital, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8108-9064","authenticated-orcid":false,"given":"Francesca","family":"Ratti","sequence":"additional","affiliation":[{"name":"Hepatobiliary Surgery Division, San Raffaele Hospital, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2276-2669","authenticated-orcid":false,"given":"Carlo","family":"Sposito","sequence":"additional","affiliation":[{"name":"Department of Oncology and Hemato-Oncology, University of Milan and Department of Surgery, HPB Surgery and Liver Transplantation, Istituto Nazionale Tumori IRCCS, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martina","family":"Nebbia","sequence":"additional","affiliation":[{"name":"Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel M.","family":"D\u2019Souza","sequence":"additional","affiliation":[{"name":"Department of Surgery, McMaster University, Hamilton, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Franco","family":"Pascual","sequence":"additional","affiliation":[{"name":"Department of Surgery, Paul Brousse Hospital, Villejuif, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Epameinondas","family":"Dogeas","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samer","family":"Tohme","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3114-8521","authenticated-orcid":false,"given":"Francesco E.","family":"D\u2019Amico","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Padua, Padua, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5643-0104","authenticated-orcid":false,"given":"Remo","family":"Alessandris","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Padua, Padua, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6172-1317","authenticated-orcid":false,"given":"Ilaria","family":"Simonelli","sequence":"additional","affiliation":[{"name":"Laltrastatistica Consultancy and Training, Biostatistics Department, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3606-9512","authenticated-orcid":false,"given":"Celeste","family":"Del Basso","sequence":"additional","affiliation":[{"name":"Department of Surgery, San Camillo Forlanini Hospital, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadia","family":"Russolillo","sequence":"additional","affiliation":[{"name":"Department of Surgery, Mauriziano Hospital, Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amika","family":"Moro","sequence":"additional","affiliation":[{"name":"Department of Surgery, Cleveland Clinic, Cleveland, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1186-1979","authenticated-orcid":false,"given":"Guido","family":"Fiorentini","sequence":"additional","affiliation":[{"name":"Hepatobiliary Surgery Division, San Raffaele Hospital, Milan, Italy"},{"name":"Department of Surgery, Mayo Clinic, Rochester, New York State, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1471-8585","authenticated-orcid":false,"given":"Matteo","family":"Serenari","sequence":"additional","affiliation":[{"name":"Hepato-biliary Surgery and Transplant Unit, IRCCS Sant\u2019Orsola Hospital, University of Bologna, Bologna, Italy and Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6557-0712","authenticated-orcid":false,"given":"Fernando","family":"Rotellar","sequence":"additional","affiliation":[{"name":"HPB and Liver Transplant Unit, Clinica Universidad de Navarra, University of Navarra. Institute of Health Research of Navarra (IdisNA), Pamplona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Zimmitti","sequence":"additional","affiliation":[{"name":"Department of Surgery, Poliambulanza Foundation Hospital, Brescia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simone","family":"Famularo","sequence":"additional","affiliation":[{"name":"Hepatobiliary Surgery Division, Humanitas University and Research Hospital- IRCCS, Rozzano - Milano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1312-4470","authenticated-orcid":false,"given":"Tommy","family":"Ivanics","sequence":"additional","affiliation":[{"name":"Abdominal Transplant and HPB Surgical Oncology, Division of General Surgery, Toronto General Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2302-6786","authenticated-orcid":false,"given":"Daniel","family":"Hoffman","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of California, San Francisco, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edwin","family":"Onkendi","sequence":"additional","affiliation":[{"name":"Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasmin","family":"Essaji","sequence":"additional","affiliation":[{"name":"Department of Surgery, Virginia Mason Hospital and Seattle Medical Center, Seattle, Washington, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5192-9966","authenticated-orcid":false,"given":"Santiago","family":"Lopez Ben","sequence":"additional","affiliation":[{"name":"Department of Surgery, Hospital Universitari Dr Josep Trueta de Girona, Girona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Celia","family":"Caula","sequence":"additional","affiliation":[{"name":"Department of Surgery, Hospital Universitari Dr Josep Trueta de Girona, Girona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianluca","family":"Rompianesi","sequence":"additional","affiliation":[{"name":"Department of clinical medicine and surgery, division of HPB, minimally invasive and robotic surgery, transplantation service, Universit\u00e0 Federico II, Naples, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5908-3993","authenticated-orcid":false,"given":"Asmita","family":"Chopra","sequence":"additional","affiliation":[{"name":"Department of Surgery, Promedica, Toledo, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed","family":"Abu Hilal","sequence":"additional","affiliation":[{"name":"Department of Surgery, Poliambulanza Foundation Hospital, Brescia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5798-5021","authenticated-orcid":false,"given":"Guido","family":"Torzilli","sequence":"additional","affiliation":[{"name":"Hepatobiliary Surgery Division, Humanitas University and Research Hospital- IRCCS, Rozzano - Milano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gonzalo","family":"Sapisochin","sequence":"additional","affiliation":[{"name":"Abdominal Transplant and HPB Surgical Oncology, Division of General Surgery, Toronto General Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos","family":"Corvera","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of California, San Francisco, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adnan","family":"Alseidi","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of California, San Francisco, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott","family":"Helton","sequence":"additional","affiliation":[{"name":"Department of Surgery, Virginia Mason Hospital and Seattle Medical Center, Seattle, Washington, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto I.","family":"Troisi","sequence":"additional","affiliation":[{"name":"Department of clinical medicine and surgery, division of HPB, minimally invasive and robotic surgery, transplantation service, Universit\u00e0 Federico II, Naples, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kerri","family":"Simo","sequence":"additional","affiliation":[{"name":"Department of Surgery, Promedica, Toledo, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudius","family":"Conrad","sequence":"additional","affiliation":[{"name":"Department of Surgery, Saint Elizabeth Medical Center, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matteo","family":"Cescon","sequence":"additional","affiliation":[{"name":"Hepato-biliary Surgery and Transplant Unit, IRCCS Sant\u2019Orsola Hospital, University of Bologna, Bologna, Italy and Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sean","family":"Cleary","sequence":"additional","affiliation":[{"name":"Department of Surgery, Mayo Clinic, Rochester, New York State, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Choon H.D.","family":"Kwon","sequence":"additional","affiliation":[{"name":"Department of Surgery, Cleveland Clinic, Cleveland, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Ferrero","sequence":"additional","affiliation":[{"name":"Department of Surgery, Mauriziano Hospital, Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7501-5472","authenticated-orcid":false,"given":"Giuseppe M.","family":"Ettorre","sequence":"additional","affiliation":[{"name":"Department of Surgery, San Camillo Forlanini Hospital, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Umberto","family":"Cillo","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Padua, Padua, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Geller","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Cherqui","sequence":"additional","affiliation":[{"name":"Department of Surgery, Paul Brousse Hospital, Villejuif, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3715-6880","authenticated-orcid":false,"given":"Pablo E.","family":"Serrano","sequence":"additional","affiliation":[{"name":"Department of Surgery, McMaster University, Hamilton, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina","family":"Ferrone","sequence":"additional","affiliation":[{"name":"Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincenzo","family":"Mazzaferro","sequence":"additional","affiliation":[{"name":"Department of Oncology and Hemato-Oncology, University of Milan and Department of Surgery, HPB Surgery and Liver Transplantation, Istituto Nazionale Tumori IRCCS, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7729-2468","authenticated-orcid":false,"given":"Luca","family":"Aldrighetti","sequence":"additional","affiliation":[{"name":"Hepatobiliary Surgery Division, San Raffaele Hospital, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T. Peter","family":"Kingham","sequence":"additional","affiliation":[{"name":"Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2023,1,3]]},"reference":[{"key":"R1-20250824","doi-asserted-by":"crossref","first-page":"846","DOI":"10.1111\/j.1477-2574.2011.00380.x","article-title":"Metabolic syndrome and hepatic resection: improving outcome","volume":"13","author":"Agrawal","year":"2011","journal-title":"HPB (Oxford)"},{"key":"R2-20250824","first-page":"19","article-title":"A clinical perspective of the link between metabolic syndrome and hepatocellular carcinoma","volume":"2","author":"Cauchy","year":"2015","journal-title":"J Hepatocell Carcinoma"},{"key":"R3-20250824","doi-asserted-by":"crossref","first-page":"624","DOI":"10.1097\/SLA.0b013e31826b4b7e","article-title":"Liver transplantation for nonalcoholic steatohepatitis: the new epidemic","volume":"256","author":"Agopian","year":"2012","journal-title":"Ann Surg"},{"key":"R4-20250824","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1038\/bjc.2012.492","article-title":"Metabolic syndrome and hepatocellular carcinoma risk","volume":"108","author":"Turati","year":"2013","journal-title":"Br J Cancer"},{"key":"R5-20250824","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1016\/j.jhep.2018.03.019","article-title":"Electronic address eee, European Association for the Study of the L. 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