Preoperative albumin-bilirubin score and liver resection percentage determine postoperative liver regeneration after partial hepatectomy

doi:10.3748/wjg.v30.i14.2006

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Gastroenterol. Apr 14, 2024; 30(14): 2006-2017
Published online Apr 14, 2024. doi: 10.3748/wjg.v30.i14.2006

Table 1 Demographics, n (%)

	RH/Tri group (n = 41)	LH group (n = 53)	Seg group (n = 99)	Sub/Non group (n = 75)	P value
Baseline characteristics
Age	68 (16-80)	69 (14-86)	68 (46-83)	70 (52-90)	0.06
Sex, male, yes	29 (71)	33 (62)	73 (74)	58 (77)	0.29
BMI (kg/m²)	21.8 (15.4-31.3)	22.3 (15.2-29.4)	230 (15.5-32.8)	23.4 (17.8-35.5)	0.009
Background disease
HCC	21 (51)	14 (26)	63 (64)	56 (75)	< 0.001
CCC & CHC	4 (10)	19 (36)	9 (9)	8 (11)	-
Colorectal liver metastasis	10 (24)	6 (11)	16 (16)	11 (15)	-
Others	6 (15)	14 (26)	11 (11)	0 (0)	-
HCV, yes	6 (15)	9 (17)	26 (26)	29 (39)	0.01
Liver resection percentage	52 (21-71)	32 (13-49)	27 (10-56)	15 (10-32)	< 0.001
Diabetes mellitus, yes	13 (32)	16 (30)	34 (34)	33 (44)	0.36
Renal complication	3 (7)	3 (6)	6 (6)	6 (8)	0.94
Heavy alcoholic¹	15 (37)	9 (17)	39 (39)	32 ()	0.03
ICG 15 min	10.7 (0.1-81.1)	9.0 (1.4-66.4)	10.1 (1.3-80.0)	11.5 (2.8-33.4)	0.65
Preoperative ALBI score	-2.56 (-3.46 to -1.40)	-2.73 (-3.50 to -0.69)	-2.85 (-3.75 to -1.51)	-2.78 (-3.38 to -1.82)	0.07
Preoperative platelet count (/uL)	205 (95-562)	198 (78-504)	186 (61-542)	182 (91-396)	0.02
Liver cirrhosis (F4), yes	4 (10)	2 (4)	18 (18)	9 (12)	0.08
Laparoscopic hepatectomy	3 (7)	2 (38)	13 (13)	7 (9)	0.28
Re-hepatectomy	3 (7)	4 (8)	5 (5)	7 (9)	0.74
Preoperative Chemotherapy	10 (24)	9 (17)	15 (15)	5 (7)	0.06
Postoperative outcomes
Operation time (min)	383 (218-644)	354 (183-629)	388 (151-742)	341 (153-584)	0.008
Intraoperative blood loss (mL)	680 (110-13360)	378 (68-3660)	525 (0-32150)	470 (0-1894)	0.25
RBC transfusion	6 (15)	3 (6)	8 (8)	3 (4)	0.19
Total Pringle time (min)	56 (0-179)	45 (0-131)	75 (0-202)	78 (0-167)	< 0.001
Posthepatectomy liver failure grade B/C	10 (24)	3 (6)	7 (7)	3 (4)	0.001
Complication CD grade ≥ 3	9 (22)	10 (19)	22 (22)	12 (16)	0.75
Length of Hospital stay (d)	16 (7-41)	11 (5-54)	11 (6-40)	11 (6-167)	0.46

¹Daily alcohol consumption 30 g/d or higher.

RH/Tri: Right hepatectomy/Trisegmentectomy; LH: Left hepatectomy; Seg: Segmentectomy; Sub/Non: Subsegmentectomy and nonanatomical hepatectomy; BMI: Body mass index; HCC: Hepatocellular carcinoma; CCC: Cholangiocellular carcinoma; CHC: Combined hepatocellular carcinoma and cholangiocellular carcinoma; HCV: Hepatitis C virus; ALBI: Albumin-bilirubin; ICG: Indocyanine green; RBC: Red blood cell; CD: Clavien-Dindo.

Table 2 Risk factors for low regeneration at 3-months and 12-months posthepatectomy

	3-months (n = 187)				12-months (n = 192)
	Univariate OR (95%CI)	P value	Multivariate OR (95%CI)	P value	Univariate OR (95%CI)	P value	Multivariate OR (95%CI)	P value
Age > 75, yes	0.69 (0.30-1.56)	0.37	-	-	0.48 (0.19-1.24)	0.13	-	-
Sex, male, yes	1.40 (0.66-32.94)	0.38	-	-	0.79 (0.39-1.62)	0.79	-	-
BMI >28 kg/m², yes	0.19 (0.02-1.44)	0.11	-	-	0.42 (0.09-1.94)	0.42	-	-
Background, HCC	-	Ref.			-	Ref.
CCC & CHC	0.30 (0.09-1.08)	0.07	0.31 (0.08-1.17)	0.08	0.81 (0.31-2.07)	0.65	-	-
Colorectal liver metastasis	0.98 (0.41-2.38)	0.96	0.88 (0.35-2.21)	0.79	0.88 (0.34-2.27)	0.79	-	-
Others	0.76 (0.31-2.37)	0.76	0.93 (0.30-2.88)	0.90	0.97 (0.35-2.71)	0.96	-	-
HCV positive, yes	0.63 (0.29-1.38)	0.25	-	-	1.18 (0.58-2.39)	0.65
Diabetes mellitus, yes	0.93 (0.47-1.83)	0.84	-	-	0.77 (0.39-1.52)	0.45	-	-
Renal complication, yes	2.50 (0.73-8.60)	0.15	-	-	0.51 (0.11-2.37)	0.39	-	-
Heavy alcoholic, yes	1.10 (0.56-2.18)	0.77	-	-	0.86 (0.44-1.69)	0.66	-	-
Preoperative platelet count < 100 × 10³/L, yes	2.19 (0.47-10.13)	0.32			5.30 (1.22-23.09)	0.03	5.01 (1.14-21.95)	0.03
Preoperative ALBI score (per 1.0 up)	2.85 (1.21-6.71)	0.02	2.80 (1.17-6.69)	0.02	2.33 (1.05-5.18)	0.04	2.27 (1.01-5.09)	0.04
ICG 15 minutes rate (per 1.0 up)	0.97 (0.93-1.01)	0.15	-	-	1.00 (0.97-1.04)	0.92	-	-
Liver cirrhosis (F4), yes	1.22 (0.47-23.14)	0.69	-	-	1.42 (0.51-3.97)	0.51	-	-
Preoperative chemotherapy, yes	0.66 (0.25-1.73)	0.40	-	-	0.84 (0.32-2.24)	0.73	-	-
Re-hepatectomy, yes	2.65 (0.84-8.33)	0.09	2.81 (0.84-9.47)	0.09	0.28 (0.04-2.25)	0.23	-	-
Liver resection percentage (per 1.0% up)	1.01 (0.99-1.04)	0.22	-	-	1.01 (0.99-1.04)	0.24	-	-
Intraoperative blood loss > 1000mL, yes	1.73 (0.83-3.62)	0.14	-	-	1.04 (0.47-2.34)	0.92	-	-
RBC transfusion, yes	0.75 (0.20-2.82)	0.67	-	-	0.81 (0.22-3.02)	0.75	-	-
Pringle time > 90 min, yes	1.07 (0.49-2.34)	0.86	-	-	1.09 (0.51-2.31)	0.83	-	-
Posthepatectomy liver failure grade B/C, yes	0.58 (0.16-2.10)	0.41	-	-	0.72 (0.21-2.93)	0.72	-	-
Postoperative complication CD grade ≥ 3, yes	0.31 (0.11-0.84)	0.02	0.29 (0.10-0.82)	0.02	1.79 (0.83-3.87)	0.14	-	-

OR: Odds ratio; BMI: Body mass index; HCC: Hepatocellular carcinoma; CCC: Cholangiocellular carcinoma; CHC: Combined hepatocellular carcinoma and cholangiocellular carcinoma; HCV: Hepatitis C virus; ALBI: Albumin-bilirubin; ICG: Indocyanine green; RBC: Red blood cell; CD: Clavien-Dindo.

Table 3 Risk factors for delayed regeneration and failure for restoration of the original volume

	Delayed regeneration (total n = 153)				Volume restoration failure (total n = 191)
	Univariate OR (95%CI)	P value	Multivariate OR (95%CI)	P value	Univariate OR (95%CI)	P value	Multivariate OR (95%CI)	P value
Age > 75, yes	0.67 (0.27-1.68)	0.45	-	-	0.94 (0.46-1.94)	0.88	-	-
Gender, male, yes	1.14 (0.48-2.67)	0.77	-	-	0.76 (0.40-1.45)	0.41	-	-
BMI > 28 kg/m², yes	0.22 (0.03-1.74)	0.15	-	-	0.44 (0.14-1.46)	0.18	-	-
Background, HCC	-	Ref.			-	Ref.
CCC & CHC	0.49 (0.13-1.82)	0.29	-	-	1.64 (0.73-3.65)	0.23	0.40 (0.15-1.11)	0.08
Colorectal liver metastasis	1.83 (0.73-4.56)	0.19	-	-	0.88 (0.34-1.90)	0.81	0.71 (0.22-2.26)	0.56
Others	1.10 (0.27-4.42)	0.90	-	-	2.39 (0.95-6.00)	0.07	0.28 (0.08-0.97)	0.44
HCV positive, yes	0.61 (0.26-1.47)	0.27	-	-	0.70 (0.37-1.34)	0.28	-	-
Diabetes mellitus, yes	0.64 (0.30-1.39)	0.26	-	-	0.55 (0.30-1.00)	0.05	0.69 (0.36-1.35)	0.28
Renal complication, yes	0.89 (0.18-4.48)	0.88	-	-	1.15 (0.37-3.56)	0.81	-	-
Heavy alcoholic, yes	0.86 (0.39-1.88)	0.71	-	-	0.84 (0.46-1.53)	0.56	-	-
Preoperative platelet count < 100 × 10³/uL, yes	1.60 (0.28-9.11)	0.60	-	-	4.17 (0.82-21.21)	0.09	4.34 (0.81-23.40)	0.09
Preoperative ALBI score (per 1.0 up)	1.13 (0.46-2.81)	0.79	-	-	2.76 (1.27-5.97)	0.01	2.63 (1.15-6.04)	0.02
ICG 15 min rate (per 1.0 up)	1.00 (0.97-1.04)	0.99	-	-	1.00 (0.98-1.04)	0.58	-	-
Liver cirrhosis (F4), yes	1.94 (0.70-5.38)	0.20	-	-	1.22 (0.47-3.15)	0.69	-	-
Preoperative chemotherapy, yes	2.01 (0.80-5.03)	0.14	-	-	0.80 (0.34-1.87)	0.60	-	-
Re-hepatectomy, yes	1.67 (0.40-7.03)	0.49	-	-	0.74 (0.21-2.62)	0.64	-	-
Liver resection percentage (per 1.0% up)	1.03 (1.00-1.05)	0.04	1.03 (1.00-1.05)	0.04	1.03 (1.01-1.05)	0.008	1.02 (1.00-1.05)	0.04
Intraoperative blood loss > 1000 mL, yes	1.35 (0.58-3.15)	0.49	-	-	1.41 (0.69-2.86)	0.34	-	-
RBC transfusion, yes	0.55 (0.12-2.58)	0.58	-	-	1.04 (0.35-3.12)	0.95	-	-
Pringle time > 90 min, yes	1.82 (0.80-4.14)	0.16	-	-	0.91 (0.46-1.81)	0.78	-	-
Posthepatectomy liver failure grade B/C, yes	0.95 (0.24-3.60)	0.92	-	-	1.83 (0.61-5.50)	0.28	-	-
Postoperative complication CD grade ≥ 3, yes	0.54 (0.19-1.53)	0.24	-	-	1.97 (0.95-4.07)	0.07	1.80 (0.83-3.91)	0.14

Citation: Takahashi K, Gosho M, Miyazaki Y, Nakahashi H, Shimomura O, Furuya K, Doi M, Owada Y, Ogawa K, Ohara Y, Akashi Y, Enomoto T, Hashimoto S, Oda T. Preoperative albumin-bilirubin score and liver resection percentage determine postoperative liver regeneration after partial hepatectomy. World J Gastroenterol 2024; 30(14): 2006-2017
URL: https://www.wjgnet.com/1007-9327/full/v30/i14/2006.htm
DOI: https://dx.doi.org/10.3748/wjg.v30.i14.2006