Ann Surg Treat Res.  2020 Feb;98(2):62-71. 10.4174/astr.2020.98.2.62.

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

• Navarro JG
• Yang SJ
• Kang I
• Choi GH
• Han DH
• Kim KS
• Choi JS

• KMID: 2469105
• DOI: http://doi.org/10.4174/astr.2020.98.2.62

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.

Keyword

Hepatectomy; Hepatocellular carcinoma; Liver failure

MeSH Terms

Carcinoma, Hepatocellular*
Cohort Studies
Consensus
Hepatectomy*
Humans
Indocyanine Green
Liver Failure*
Liver*
Multivariate Analysis
Platelet Count
Retrospective Studies
Risk Assessment
Risk Factors
Indocyanine Green

Figure

• 

  Fig. 1 Receiver operating characteristic curve of clinically relevant posthepatectomy liver failure (International Study Group of Liver Surgery grades B and C). (A) At a cutoff value of <140 (109/L), platelet count had a sensitivity of 86.7%, and specificity of 74.7% for predicting clinically relevant posthepatectomy liver failure. The optimal cutoff value for remnant liver volume-to-body weight (RLV/BW) ratio was 0.55 (sensitivity, 80%; specificity, 73.3%), while remnant liver volume/total functional liver volume (RLV/TFLV) ratio was 35 (sensitivity, 80%; specificity, 57.3%) of the primary cohort. (B) Optimal value of liver stiffness is 11.1 kPa (sensitivity, 66.7%; specificity, 57.3%), while indocyanine green retention rate at 15 minutes has an optimal cutoff value of 11.1 (sensitivity, 26.7%; specificity, 76%) of the primary cohort. (C) In the validation cohort, the optimal cutoff values for platelet count, RLV/BW ratio, and RLV/TFLV ratio were the same as the primary cohort.

• 

  Fig. 2 Percentage risk of patients with hepatocellular carcinoma who underwent right hepatectomy according to the number of risk factors (platelet count < 140 [109/L] and remnant liver volume-to-body weight ratio < 0.55). (A) Primary cohort and (B) validation cohort. High risk, platelet count < 140 (109/L), and RLV/BW ratio < 0.55; intermediate risk, either platelet count < 140 (109/L) or RLV/BW ratio < 0.55; low risk, platelet count > 140 (109/L) and RLV/BW ratio > 0.55. CRPHLF, clinically relevant posthepatectomy liver failure; RLV/BW, remnant liver volume-to-body weight.

• 

  Fig. 3 Percentage risk of patients with hepatocellular carcinoma who underwent right hepatectomy according to the (platelet count < 140 [109/L] and remnant liver volume-to-body weight ratio < 0.55). (A) Patients with liver cirrhosis and (B) patients with no liver cirrhosis. High risk, platelet count < 140 (109/L) and RLV/BW ratio < 0.55; intermediate risk, either platelet count < 140 (109/L) or RLV/BW ratio < 0.55; low risk, platelet count > 140 (109/L) and RLV/BW ratio > 0.55. CRPHLF, clinically relevant posthepatectomy liver failure; RLV/BW, remnant liver volume-to-body weight.

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