Risk factors of posthepatectomy liver failure for perihilar cholangiocarcinoma: Risk score and significance of future liver remnant volume‐to‐body weight ratio. Issue 3 (18th May 2020)

• Record Type: Journal Article
• Authors: Lee, Jong W.; Lee, Jae H.; Park, Yejong; Lee, Woohyung; Kwon, Jaewoo; Song, Ki B.; Hwang, Dae W.; Kim, Song C.
• Is Part Of: Journal of surgical oncology. Volume 122:Issue 3(2020)
• Page Start: 469
• Page End: 479
• Publication Date: 2020-05-18
• Subjects: body weight -- future liver remnant volume -- hilar cholangiocarcinoma -- liver failure -- risk score; Cancer -- Surgery -- Periodicals; Neoplasms -- Periodicals; 616
• DOI: 10.1002/jso.25974
• Languages: English
• ISSNs: 0022-4790

Abstract

Abstract: Background: Surgery for perihilar cholangiocarcinoma (PHCC) is associated with high morbidity. This study aimed to investigate the clinical value of the future liver remnant volume‐to‐body weight (FLRV/BW) and propose a risk score for predicting the risk of patients with PHCC developing posthepatectomy liver failure (PHLF). Methods: This study included 348 patients who underwent major hepatectomy with bile duct resection for PHCC during 2008‐2015 at a single center in Korea and they were retrospectively analyzed. Results: Clinically relevant PHLF was noted in 40 patients (11.4%). The area under the curve (AUC) for FLRV/BW was not significantly different from that for FLRV/total liver volume ( P = .803) or indocyanine green clearance of the future liver remnant ( P = .629) in terms of predicting PHLF. On multivariate analysis, predictors of PHLF ( P < .05) were male sex, albumin less than 3.5 g/dL, preoperative cholangitis, portal vein resection, FLRV/BW less than 0.5%, and FLRV/BW 0.5% to 0.75%. These variables were included in the risk score that showed good discrimination (AUC, 0.853; 95% CI, 0.802‐0.904). It will help rank patients into three risk subgroups with a predicted liver failure incidence of 4.75%, 18.73%, and 51.58%, respectively. Conclusions: FLRV/BW is a comparable risk prediction factor of PHLF and the proposed risk score can help to predict the risk of planned surgery in PHCC.