Published online Oct 14, 2022. doi: 10.3748/wjg.v28.i38.5614
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
Estimation of the functional reserve of the remnant liver is important to reduce morbidity and mortality.
To estimate the functional reserve of the remnant liver in patients with hepatocellular carcinoma (HCC).
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.
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.
The measurement of hepatic clearance may predict PHLF and major complications for patients undergoing resection of HCC.
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.