Future liver volume combined with platelet count predicts liver failure after major hepatectomy. Issue 6 (December 2022)

• Record Type: Journal Article
• Authors: Cai, Hao; Zhu, Xiao-Dong; Li, Xiao-Long; Shen, Ying-Hao; Huang, Cheng; Shi, Guo-Ming; Tang, Min; Wu, Dong; Deng, Min; Sun, Hui-Chuan
• Is Part Of: Surgeon. Volume 20:Issue 6(2022)
• Page Start: e416
• Page End: e422
• Publication Date: 2022-12
• Subjects: Future remnant liver volume -- Liver function reserve -- Platelet -- Major hepatectomy -- Post-hepatectomy liver failure; Surgery -- Periodicals; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; 617
• DOI: 10.1016/j.surge.2022.02.004
• Languages: English
• ISSNs: 1479-666X

Abstract

Abstract: Background: Major hepatectomy is associated with high incidence of post-hepatectomy liver failure (PHLF). This study aimed to evaluate the effect of future remnant liver volume combined with liver function tests on predicting PHLF. Methods: Patients who underwent major hepatectomy from April 2009 to May 2017 were enrolled in the training cohort. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors of PHLF and generate a logistic regression model for the prediction of PHLF. A conditional inference tree was generated based on the optimal cutoff value of independent predictive factors of PHLF. The precedent results were validated in an independent cohort from June 2017 to March 2018. Results: One hundred and eighteen patients were included in the training cohort, while another 34 in the validation cohort. Future remnant liver volume/estimated standard total liver volume (FLV/eTV) and preoperative platelet count were independent predictive factors of PHLF (P = 0.0021 and P = 0.012, respectively). The conditional inference tree showed that patients with FLV/eTV ≤0.56 and PLT count ≤145 × 10 9 /L were at high risk of developing PHLF. Conclusion: FLV/eTV combined with preoperative PLT count is effective in predicting PHLF after major hepatectomy. Highlights: Major hepatectomy is associated with a high risk of post-hepatectomy liver failure (PHLF). Future remnant liver volume/estimated standard total liver volume (FLV/eTV) and pre-operative platelet (PLT) count are two independent risk factors of PHLF. A decision tree was generated base on the optimal cutoff values of FLV/eTV and PLT count. Compared with the 2018 EASL guideline, the results of our study are more applicable to the east Asia populations, and are applicable to liver tumors other than hepatocellular carcinoma.