Retrospective Cohort Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 21, 2020; 26(7): 725-739
Published online Feb 21, 2020. doi: 10.3748/wjg.v26.i7.725
Pre-hepatectomy type IV collagen 7S predicts post-hepatectomy liver failure and recovery
Masatsugu Ishii, Osamu Itano, Masahiro Shinoda, Minoru Kitago, Yuta Abe, Taizo Hibi, Hiroshi Yagi, Ayano Takeuchi, Hanako Tsujikawa, Tokiya Abe, Yuko Kitagawa
Masatsugu Ishii, Masahiro Shinoda, Minoru Kitago, Yuta Abe, Hiroshi Yagi, Yuko Kitagawa, Department of Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan
Osamu Itano, Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare School of Medicine, Chiba 286-8686, Japan
Taizo Hibi, Department of Pediatric Surgery and Transplantation, Kumamoto University, Kumamoto 860-8556, Japan
Ayano Takeuchi, Department of Public Health, Keio University School of Medicine, Tokyo 160-8582, Japan
Hanako Tsujikawa, Tokiya Abe, Department of Pathology, Keio University School of Medicine, Tokyo 160-8582, Japan
Author contributions: All authors equally contributed to this paper.
Institutional review board statement: This study was approved by the ethics committee of Keio University Hospital (approval Nos. 20120443 and 20140389).
Informed consent statement: All patients involved in this study provided informed consent prior to their study inclusion.
Conflict-of-interest statement: All other authors have nothing to disclose.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Osamu Itano, MD, PhD, Professor, Surgeon, Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare School of Medicine, 4-3 Kozunomori, Narita, Chiba 286-8686, Japan. laplivertiger@gmail.com
Received: November 22, 2019
Peer-review started: November 22, 2019
First decision: December 7, 2019
Revised: January 12, 2020
Accepted: January 19, 2020
Article in press: January 19, 2020
Published online: February 21, 2020
Processing time: 90 Days and 17.1 Hours
Abstract
BACKGROUND

Liver resection is an effective treatment for benign and malignant liver tumors. However, a method for preoperative evaluation of hepatic reserve has not yet been established. Previously reported assessments of preoperative hepatic reserve focused only on liver failure in the early postoperative period and did not consider the long-term recovery of hepatic reserve. When determining eligibility for hepatectomy, the underlying pathophysiology needs to be considered to determine if the functional hepatic reserve can withstand both surgery and any postoperative therapy.

AIM

To identify pre-hepatectomy factors associated with both early postoperative liver failure and long-term postoperative liver function recovery.

METHODS

This study was a retrospective cohort study. We retrospectively investigated 215 patients who underwent hepatectomy at our hospital between May 2013 and December 2016. Early post-hepatectomy liver failure (PHLF) was defined using the International Study Group of Liver Surgery’s definition of PHLF. Long-term postoperative recovery of liver function was defined as the time taken for serum total bilirubin and albumin levels to return to levels of < 2 mg/dL and > 2.8 g/dL, respectively, and the time taken for Child-Pugh score to return to Child-Pugh class A.

RESULTS

Preoperative type IV collagen 7S was identified as a significant independent factor associated with both PHLF and postoperative long-term recovery of liver function. Further analysis revealed that the time taken for the recovery of Child-Pugh scores and serum total bilirubin and albumin levels was significantly shorter in patients with type IV collagen 7S ≤ 6 ng/mL than in those with type IV collagen 7S > 6 ng/mL. In additional analyses, similar results were observed in patients without chronic viral hepatitis associated with fibrosis.

CONCLUSION

Preoperative type IV collagen 7S is a preoperative predictor of PHLF and long-term postoperative liver function recovery. It can also be used in patients without chronic hepatitis virus.

Keywords: Hepatectomy; Liver failure; Type IV collagen 7S; Liver fibrosis; Postoperative complications; Long-term postoperative liver function recovery

Core tip: In this study, we identified the pre-hepatectomy factor associated with both early postoperative liver failure and long-term postoperative liver function recovery. We found that preoperative type IV collagen 7S is a significant independent factor associated with both post-hepatectomy liver failure and postoperative long-term recovery of liver function. Our analysis revealed that the time required for the recovery of Child-Pugh scores and serum total bilirubin and total bilirubin levels was significantly shorter in patients with type IV collagen 7S ≤ 6 ng/mL than in patients with type IV collagen 7S > 6 ng/mL.