Clearance of the liver remnant predicts short-term outcome in patients undergoing resection of hepatocellular carcinoma

Table 1 Patient characteristics

Variables	All patients (n = 199)	No PHLF < Grade B (n = 187)	PHLF ≥ Grade B (n = 12)	P value
General
Age (yr)	69.1 ± 9.0	69.2 ± 9.12	66.9 ± 7.05	0.53
Gender (male : female)	154 : 45	144 : 43	10 : 2	0.61
Child–Pugh class (A : B : C)	196 : 3 :0	184 : 3 : 0	12 : 0 : 0	0.31
Preoperative laboratory tests
Total bilirubin (mg/dL)	0.85 ± 0.38	0.82 ± 0.38	1.06 ± 0.32	0.01
PT-INR	1.12 ± 0.20	1.12 ± 0.21	1.13 ± 0.08	0.70
Albumin (mg/dL)	4.1 ± 0.5	4.1 ± 0.5	3.9 ± 0.4	0.16
AST (IU/L)	43 ± 41	41 ± 40	56 ± 47	0.11
ALT (IU/L)	40 ± 34	39 ± 33	47 ± 40	0.31
Choline esterase(U/L)	262 ± 77	267 ± 76	226 ± 73	0.02
PNI score	48.6 ± 6.0	48.9 ± 6.0	46.4 ± 5.6	0.08
ALBI score	-2.76 ± 0.4	-2.78 ± 0.4	-2.57 ± 0.35	0.14
NLR	2.48 ± 2.03	2.50 ± 2.12	2.31 ± 1.07	0.82
PLR	0.12 ± 0.08	0.13 ± 0.09	0.10 ± 0.05	0.29
Procedure-related factors
Limited resection	80 (39.8%)	77 (38.7%)	3 (1.5%)	0.43
Segmentectomy	57 (28.4%)	51 (25.6%)	6 (3.0%)
Secteionectomy	36 (17.9%)	33 (16.6%)	1 (0.5%)
Hemihepatectomy	24 (11.9%)	22 (11.1%)	2 (1.0%)
Trisectionectomy	4 (2.0%)	4 (2.1%)	0 (0%)
Operative time (min)	304 ± 109	299 ± 104	345 ± 135	0.06
Intraoperative blood loss (mL)	848 ±1006	743 ± 889	1604 ± 1456	< 0.001
Liver function tests
Total Liver hepatic clearance (mL/min)	285 ± 98	315 ± 106	258 ± 91	0.02
Total Liver Functional volume (mL)	1321 ± 280	1340 ± 278	1202 ± 270	0.04
Hepatic clearance of the remnant liver (mL/min)	248 ± 95	261 ± 91	149 ± 47	< 0.001
Functional volume of the remnant liver (mL)	1057 ± 334	1104 ± 317	710 ± 239	< 0.001
LHL15	0.92 ± 0.03	0.925 ± 0.03	0.906 ± 0.05	0.02
HH15	0.60 ± 0.07	0.602 ± 0.07	0.651 ± 0.07	0.01
Surgical outcome
PHLF grade (0 : A : B : C)	176 : 11 : 8 : 4	176 : 11 : 0 : 0	0 : 0 : 8 : 4	-
Hospital length of stay (d)	15 (7-119)	14 (7-119)	25 (12-74)	< 0.001

PNI: Prognostic nutrition index; ALBI: Albumin–bilirubin; NLR: Neutrophil–lymphocyte ratio; PLR: Platelet-to-lymphocyte ratio; LHL15: liver to heart-plus-liver radioactivity at 15 min; PHLF: Posthepatectomy liver failure; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; PT-INR: Prothrombin time international normalized ratio.

Table 2 Postoperative morbidity in patients with hepatocellular carcinoma

Complication	Clavien–Dindo classification							Total (%)
	I	II	IIIa	IIIb	IVa	IVb	V
Pleural effusion or ascites	6		1					7 (3.5)
Pneumonia		1	1					2 (1.0)
Biliary leakage		1	5					6 (3.0)
Arrhythmia	1							1 (1.0)
Wound infection	10							10 (5.0)
Intra-abdominal abscess		1	8					9 (4.5)
Intra-abdominal hemorrhage			1	1				2 (1.0)
PHLF	8	5	5	2	1		2	23 (11.6)
Total (%)	25 (12.5)	8 (4.0)	21 (10.6)	3 (1.5)	1 (0.5)	0	2 (1.0)	60 (30.0)

PHLF: Posthepatectomy liver failure.

Table 3 Predictive factors for post-hepatectomy liver failure in grade B, or C

	Univariate analysis			Multivariate analysis
	P	OR	95%CI	P	OR	95%CI
Age (yr)	0.53	1.02	0.96-1.08
Gender (male : female)	0.59	0.67	0.10-2.66
Child–Pugh class	0.47	1.63	0.06-1.63
PT-INR	0.86	0.79	0.05-11.0
AST	0.34	0.99	0.98-1.00
ALT	0.14	0.99	0.98-1.00
Choline Esterase	0.24	1.00	0.99-1.01
ALBI score	0.15	0.37	0.09-1.41	0.375	3.31	0.37-29.3
Operation time	0.02	1.01	0.99-1.00	0.110	1.010	0.99-1.01
Intraoperative blood loss	0.001	1.0007	1.0003-1.0012	0.033	1.001	1.0002-1.002
Hepatic clearance of the remnant liver	< 0.001	0.972	0.958-0.987	0.002	0.973	0.952-0.995
Functional volume of the remnant liver	0.002	0.997	0.994-0.999	0.351	0.998	0.995-1.00
LHL15	0.02	52	2.03-1382	0.362	9.597	0.08-1211

AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; PT-INR: Prothrombin time international normalized ratio; ALBI: Albumin-bilirubin; LHL15: liver to heart-plus-liver radioactivity at 15 min; OR: Odds ratio; CI: Confidence interval.

Table 4 Predictive factors for morbidity (Clavien–Dindo classification ≥ IIIa)

	Univariate analysis			Multivariate analysis
	P	OR	95%CI	P	OR	95%CI
Age (yr)	0.68	1.01	0.96-1.06
Gender (male : female)	0.69	0.80	0.27-2.36
Child–Pugh class	0.89	1.09	0.29-2.91
PT-INR	0.97	1.03	0.09-11.6
AST	0.27	0.99	0.98-1.00
ALT	0.11	0.99	0.98-1.00
Cholinesterase	0.58	1.00	0.99-1.01
ALBI score	0.02	3.57	1.19-10.7	0.790	1.22	0.286-5.19
Operation time	0.01	1.01	1.00-1.01	0.166	1.004	0.991-1.015
Intraoperative blood loss	0.001	1.0006	1.0002-1.001	0.005	1.0005	1.0002-1.0014
Hepatic clearance of the remnant liver	< 0.001	0.986	0.978-0.994	0.004	0.988	0.979-0.999
Functional volume of the remnant liver	0.003	0.998	0.996-0.999	0.329	0.99	0.997-1.00
LHL15	0.13	9.9	0.53-183	0.914	1.27	0.02-99.2

AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; PT-INR: Prothrombin time international normalized ratio; ALBI: Albumin-bilirubin; LHL15: liver to heart-plus-liver radioactivity at 15 min; OR: Odds ratio; CI: Confidence interval.