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

Jonathan Geograpo Navarro; Seok Jeong Yang; Incheon Kang; Gi Hong Choi; Dai Hoon Han; Kyung Sik Kim; Jin Sub Choi

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자료유형: 학술저널

저자정보: Jonathan Geograpo Navarro (Yonsei University College of Medicine) Seok Jeong Yang (Yonsei University College of Medicine) Incheon Kang (Yonsei University College of Medicine) Gi Hong Choi (Yonsei University College of Medicine) Dai Hoon Han (Yonsei University College of Medicine) Kyung Sik Kim (Yonsei University College of Medicine) Jin Sub Choi (Yonsei University College of Medicine)

저널정보: 대한외과학회 Annals of Surgical Treatment and Research Annals of Surgical Treatment and Research Vol.98 No.2

발행연도: 2020.2

수록면: 62 - 71 (10page)

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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-tobody 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.

#Hepatectomy #Hepatocellular carcinoma #Liver failure

참고문헌 (30)

참고문헌 신청

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