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What are the most important predictive factors for clinically relevant posthepatectomy liver failure after right hepatectomy for hepatocellular carcinoma?

Annals of Surgical Treatment and Research 2020년 98권 2호 p.62 ~ 71
 ( Navarro Jonathan Geograpo ) - Vicente Sotto Memorial Medical Center Department of Surgery

 ( Yang Seok-Jeong ) - Yonsei University College of Medicine Department of Surgery
 ( Kang In-Cheon ) - Yonsei University College of Medicine Department of Surgery
 ( Choi Gi-Hong ) - Yonsei University College of Medicine Department of Surgery
 ( Han Dai-Hoon ) - Yonsei University College of Medicine Department of Surgery
김경식 ( Kim Kyung-Sik ) - Yonsei University College of Medicine Department of Surgery
 ( Choi Jin-Sub ) - Yonsei University College of Medicine Department of Surgery

Abstract


Purpose: The risk of posthepatectomy liver failure (PHLF) after right hepatectomy remains substantial. Additional parameters such as computed tomography volumetry, liver stiffness measurement by FibroScan, indocyanine green retention rate at 15 minutes, and platelet count used to properly assess future liver remnant volume quality and quantity are of the utmost importance. Thus, we compared the usefulness of these modalities for predicting PHLF among patients with hepatocellular carcinoma after right hepatectomy.

Methods: We retrospectively reviewed patients who underwent right hepatectomy for hepatocellular carcinoma between 2007 and 2013. PHLF was determined according to International Study Group of Liver Surgery consensus definition and severity grading. Grades B and C were defined as clinically relevant posthepatectomy liver failure (CRPHLF). The results were internally validated using a cohort of 97 patients.

Results: Among the 90 included patients, 15 (16.7%) had CRPHLF. Multivariate analysis confirmed that platelet count < 140 (109/L) (hazard ratio [HR], 24.231; 95% confidence interval [CI], 3.623?161.693; P = 0.001) and remnant liver volume-to-body weight (RVL/BW) ratio < 0.55 (HR, 25.600; 95% CI, 4.185?156.590; P < 0.001) were independent predictors of CRPHLF. Among the 12 patients with a platelet count < 140 (109/L) and RLV/BW ratio < 0.55, 9 (75%) had CRPHLF. Likewise, 5 of 38 (13.2%) with only one risk factor developed CRPHL versus 1 of 40 (2.5%) with no risk factors. These findings were confirmed by the validation cohort.

Conclusion: RLV/BW ratio and platelet count are more important than the conventional RLV/TFLV, indocyanine green retention rate at 15 minutes, and liver stiffness measurement in the preoperative risk assessment for CRPHLF.

키워드

Hepatectomy; Hepatocellular carcinoma; Liver failure
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