Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 14, 2022; 28(38): 5614-5625
Published online Oct 14, 2022. doi: 10.3748/wjg.v28.i38.5614
Clearance of the liver remnant predicts short-term outcome in patients undergoing resection of hepatocellular carcinoma
Atsushi Miki, Yasunaru Sakuma, Hideyuki Ohzawa, Akira Saito, Yoshiyuki Meguro, Jun Watanabe, Kazue Morishima, Kazuhiro Endo, Hideki Sasanuma, Atsushi Shimizu, Alan Kawarai Lefor, Yoshikazu Yasuda, Naohiro Sata
Atsushi Miki, Yasunaru Sakuma, Hideyuki Ohzawa, Akira Saito, Yoshiyuki Meguro, Jun Watanabe, Kazue Morishima, Kazuhiro Endo, Hideki Sasanuma, Atsushi Shimizu, Alan Kawarai Lefor, Yoshikazu Yasuda, Naohiro Sata, Department of Surgery, Jichi Medical University, Shimotsuke 329-0498, Tochigi, Japan
Author contributions: Miki A, Sakuma Y, Shimizu A and Yasuda Y designated the overall concept and outline the manuscript; Ohzawa H, Saito A, Meguro Y, Watanabe J, Morishima K, Endo K, Sasanuma H, and Sata N contributed to the discussion and design of the manuscript; Miki A and Lefor AK contributed to the writing, editing the manuscript, illustrations, and review of literature.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of Jichi Medical University, Approval No. A21-029.
Informed consent statement: Written informed consent from any patient for data collection in a prospectively collected data base is available. However, the need for written informed consent for this study was waived by the Institutional Review Board of Jichi Medical University in view of the retrospective design of the study, based on national and local guidelines such as the fact that all clinical/ laboratory measurements and procedures were part of routine care.
Conflict-of-interest statement: The authors declare no conflicts of interest for this study.
Data sharing statement: The database contains highly confidential data which may provide insight in clinical and personnel information about patients and lead to their identification. Therefore, according to organizational restrictions and regulations these data cannot be made publicly available. However, the datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Atsushi Miki, MD, PhD, Assistant Professor, Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke 329-0498, Tochigi, Japan. amiki@jichi.ac.jp
Received: November 16, 2021
Peer-review started: November 16, 2021
First decision: May 10, 2022
Revised: May 21, 2022
Accepted: August 16, 2022
Article in press: August 16, 2022
Published online: October 14, 2022
Processing time: 329 Days and 22.5 Hours
Abstract
BACKGROUND

Estimation of the functional reserve of the remnant liver is important to reduce morbidity and mortality.

AIM

To estimate the functional reserve of the remnant liver in patients with hepatocellular carcinoma (HCC).

METHODS

We reviewed the medical records of 199 patients who underwent resection of HCC. Hepatic clearance of the remnant liver was calculated using fusion images of 99mTc-labelled galactosyl-human serum albumin liver scintigraphy and computed tomography. Posthepatectomy liver failure (PHLF) was classified according to the International Study Group of Liver Surgery. Complications was classified according to Clavien–Dindo classification. We analyzed by the risk factors for PHLF, morbidity and mortality with multivariate analysis.

RESULTS

Twenty-seven (30%) patients had major complications and 23 (12%) developed PHLF. The incidence of major complications increased with increasing albumin–bilirubin (ALBI) grade. The area under the curve values for hepatic clearance of the remnant liver, liver to heart-plus-liver radioactivity at 15 min (LHL15), and ALBI score predicting PHLF were 0.868, 0.629, and 0.655, respectively. The area under the curve for hepatic clearance of the remnant liver, LHL15, and ALBI score predicting major complications were 0.758, 0.594, and 0.647, respectively. The risk factors for PHLF and major complications were hepatic clearance of the remnant liver and intraoperative bleeding.

CONCLUSION

The measurement of hepatic clearance may predict PHLF and major complications for patients undergoing resection of HCC.

Keywords: Liver function; Hepatectomy; Cirrhosis; Fusion image; Complication; Mortality

Core tip: Little is known about the association of remnant hepatic clearance with morbidity and mortality. The aim of present study was to evaluate the effectiveness of measuring hepatic clearance of the remnant liver and to determine its association with morbidity and mortality in patients undergoing hepatectomy for hepatocellular carcinoma. Risk factors significantly associated with morbidity and mortality were remnant liver clearance and intraoperative blood loss. Hepatic clearance was associated with posthepatectomy liver failure and the development of major complications. The estimation of hepatic clearance of the remnant liver may provide guidance for determining the extent of resection in a patient-specific manner.