Observational Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 14, 2024; 30(14): 2006-2017
Published online Apr 14, 2024. doi: 10.3748/wjg.v30.i14.2006
Preoperative albumin-bilirubin score and liver resection percentage determine postoperative liver regeneration after partial hepatectomy
Kazuhiro Takahashi, Masahiko Gosho, Yoshihiro Miyazaki, Hiromitsu Nakahashi, Osamu Shimomura, Kinji Furuya, Manami Doi, Yohei Owada, Koichi Ogawa, Yusuke Ohara, Yoshimasa Akashi, Tsuyoshi Enomoto, Shinji Hashimoto, Tatsuya Oda
Kazuhiro Takahashi, Yoshihiro Miyazaki, Hiromitsu Nakahashi, Osamu Shimomura, Kinji Furuya, Manami Doi, Yohei Owada, Koichi Ogawa, Yusuke Ohara, Yoshimasa Akashi, Tsuyoshi Enomoto, Shinji Hashimoto, Tatsuya Oda, Department of Gastrointestinal and Hepatobiliary-Pancreatic Surgery, University of Tsukuba, Tsukuba 3058-575, Ibaraki, Japan
Masahiko Gosho, Department of Biostatistics, University of Tsukuba, Tsukuba 3058-575, Ibaraki, Japan
Author contributions: Takahashi K designed and conducted the study and wrote the paper; Gosho M contributed to the analysis; Miyazaki Y, Nakahashi H, Shimomura O, Furuya K, Doi M, Owada Y, Ogawa K, Ohara Y, and Akashi Y provided clinical advice; and Enomoto T, Hashimoto S, and Oda T supervised the study.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of Tsukuba University Hospital.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent. We applied the Opt-out method to obtain consent for this study by using a poster. The poster was approved by the Institutional Review Board.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at kazu1123@md.tsukuba.ac.jp.
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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Kazuhiro Takahashi, FACS, MD, PhD, Assistant Professor, Surgeon, Department of Gastrointestinal and Hepatobiliary-Pancreatic Surgery, University of Tsukuba, Tennodai 1-1-1, Tsukuba 3058-575, Ibaraki, Japan. kazu1123@md.tsukuba.ac.jp
Received: December 7, 2023
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
Abstract
BACKGROUND

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.

AIM

To quantify postoperative remnant liver volume by the latest volumetric software and investigate perioperative factors that affect posthepatectomy liver regeneration.

METHODS

A total of 268 patients who received partial hepatectomy were enrolled. Patients were grouped into right hepatectomy/trisegmentectomy (RH/Tri), left hepatectomy (LH), segmentectomy (Seg), and subsegmentectomy/nonanatomical hepatectomy (Sub/Non) groups. The regeneration index (RI) and late regeneration rate were defined as (postoperative liver volume)/[total functional liver volume (TFLV)] × 100 and (RI at 6-months - RI at 3-months)/RI at 6-months, respectively. The lower 25th percentile of RI and the higher 25th percentile of late regeneration rate in each group were defined as “low regeneration” and “delayed regeneration”. “Restoration to the original size” was defined as regeneration of the liver volume by more than 90% of the TFLV at 12 months postsurgery.

RESULTS

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.

CONCLUSION

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.

Keywords: Liver regeneration, Albumin-bilirubin score, Liver resection percentage, Partial hepatectomy, Human, Regeneration index

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.