The predictive value of future liver remnant function after liver resection for HCC in noncirrhotic and cirrhotic patients

• Published in: HPB (Oxford, England) Vol. 21; no. 7; pp. 912 - 922
• Main Authors: Blüthner, Elisabeth, Jara, Maximilian, Shrestha, Ritesh, Faber, Wladimir, Pratschke, Johann, Stockmann, Martin, Malinowski, Maciej
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-07-2019
• Subjects: Aged; Carcinoma, Hepatocellular - diagnostic imaging; Carcinoma, Hepatocellular - physiopathology; Carcinoma, Hepatocellular - surgery; Female; Hepatectomy - adverse effects; Humans; Liver Cirrhosis - diagnostic imaging; Liver Cirrhosis - physiopathology; Liver Cirrhosis - surgery; Liver Neoplasms - diagnostic imaging; Liver Neoplasms - physiopathology; Liver Neoplasms - surgery; Liver Regeneration; Male; Middle Aged; Organ Size; Postoperative Complications - etiology; Predictive Value of Tests; Retrospective Studies; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome
• ISSN: 1365-182X; 1477-2574
• DOI: 10.1016/j.hpb.2018.11.012

Surgical procedures in patients with underlying liver disease are still burdened by a high rate of postoperative morbidity, especially posthepatectomy liver failure (PHLF), ranging from 1.2 to 33.8%. The aim of this study was to investigate the prognostic value of volume/function analysis for the prediction of hepatectomy-related morbidity in patients with hepatocellular carcinoma.
Clinicopathological data were analysed in 261 patients who underwent liver resection for HCC between 2001 and 2014. Future liver remnant volume (FLRV) and future liver remnant function (FLRF) based on LiMAx test were obtained retrospectively. A subgroup analysis for high-risk patients with impaired liver function was conducted. Univariate and multivariate regression analysis was performed to identify risk factors for major complications, defined by Dindo ≥ IIIb and PHLF grade ≥ B.
In the total cohort, FLRF was independently associated with major complications. FLRV, resected liver volume, and FLRF were independent risk factors for PHLF. In a subgroup analysis of high-risk patients, FLRF was identified as the only independent risk factor for major complications and PHLF development.
These results suggest the superior value of FLRF to FLRV in predicting postoperative complications as well as PHLF in patients with chronic liver disease.