Published online Apr 14, 2024. doi: 10.3748/wjg.v30.i14.2006
Peer-review started: December 7, 2023
First decision: January 24, 2024
Revised: February 5, 2024
Accepted: March 25, 2024
Article in press: March 25, 2024
Published online: April 14, 2024
The success of liver resection relies on the ability of the remnant liver to regenerate. Most of the knowledge regarding the pathophysiological basis of liver regeneration comes from rodent studies, and data on humans are scarce. Additionally, there is limited knowledge about the preoperative factors that influence postoperative regeneration.
To quantify postoperative remnant liver volume by the latest volumetric software and investigate perioperative factors that affect posthepatectomy liver regenera
A total of 268 patients who received partial hepatectomy were enrolled. Patients were grouped into right hepatectomy/trisegmentectomy (RH/Tri), left hepa
The numbers of patients in the RH/Tri, LH, Seg, and Sub/Non groups were 41, 53, 99 and 75, respectively. The RI plateaued at 3 months in the LH, Seg, and Sub/Non groups, whereas the RI increased until 12 months in the RH/Tri group. According to our multivariate analysis, the preoperative albumin-bilirubin (ALBI) score was an independent factor for low regeneration at 3 months [odds ratio (OR) 95%CI = 2.80 (1.17-6.69), P = 0.02; per 1.0 up] and 12 months [OR = 2.27 (1.01-5.09), P = 0.04; per 1.0 up]. Multivariate analysis revealed that only liver resection percentage [OR = 1.03 (1.00-1.05), P = 0.04] was associated with delayed regeneration. Furthermore, multivariate analysis demonstrated that the preoperative ALBI score [OR = 2.63 (1.00-1.05), P = 0.02; per 1.0 up] and liver resection percentage [OR = 1.02 (1.00-1.05), P = 0.04; per 1.0 up] were found to be independent risk factors associated with volume restoration failure.
Liver regeneration posthepatectomy was determined by the resection percentage and preoperative ALBI score. This knowledge helps surgeons decide the timing and type of rehepatectomy for recurrent cases.
Core Tip: Insights into posthepatectomy liver regeneration in humans are limited. We quantified liver volumes using the latest volumetric software and investigated perioperative factors that affect posthepatectomy liver regeneration. It was revealed that liver regeneration continues after 3 months of hepatectomy with more than one-fourth of the liver resection and decline in preoperative liver function, reflected by the albumin-bilirubin (ALBI) score, is associated with decreased regeneration. Furthermore, restoring to the original volume depended on the combination of the preoperative ALBI score and liver resection percentage. With this knowledge, surgeons can select an appropriate hepatectomy type with rehepatectomy in mind after intrahepatic recurrence.