Role of two-dimensional shear wave elastography in predicting post-hepatectomy liver failure: A step forwards in hepatic surgery

Abstract

This study explores the significance of using two-dimensional shear wave elastography (2D-SWE) to assess liver stiffness (LS) and spleen area (SPA) for predicting post-hepatectomy liver failure (PHLF). By providing a non-invasive method to measure LS, which correlates with the degree of liver fibrosis, and SPA, an indicator of portal hypertension, 2D-SWE offers a comprehensive evaluation of a patient’s hepatic status. These advancements are particularly crucial in hepatic surgery, where accurate preoperative assessments are essential for optimizing surgical outcomes and minimizing complications. This letter highlights the practical implications of integrating 2D-SWE into clinical practice, emphasizing its potential to improve patient safety and surgical precision by enhancing the ability to predict PHLF and tailor surgical approaches accordingly.

Key Words: Two-dimensional shear wave elastography; Liver stiffness; Spleen area; Post-hepatectomy liver failure; Non-invasive techniques; Hepatic surgery

Core Tip: Two-dimensional shear wave elastography offers a non-invasive method to predict post-hepatectomy liver failure, enhancing preoperative assessment and patient outcomes in hepatic surgery.

TO THE EDITOR

Post-hepatectomy liver failure (PHLF) remains a significant concern in hepatic surgery, impacting both patient outcomes and health care resources[1]. Recent advancements in noninvasive imaging techniques have provided new avenues for improving preoperative assessments. Among these, two-dimensional shear wave elastography (2D-SWE) has emerged as a promising tool for evaluating liver stiffness (LS) and the spleen area (SPA), both of which are critical parameters for predicting PHLF[2,3].

Significance of 2D-SWE in hepatic surgery

The authors have significantly advanced the field of hepatic surgery by demonstrating the utility of 2D-SWE in accurately assessing LS and SPA. The use of 2D-SWE in hepatic surgery has shown considerable promise due to its ability to provide accurate measurements of LS[4]. LS is directly associated with the degree of liver fibrosis, which is a critical factor in determining the liver’s functional reserve. By offering a non-invasive method to assess LS, 2D-SWE eliminates the need for more invasive procedures like liver biopsy, reducing patient risk and discomfort. This technique not only simplifies the preoperative evaluation process but also enhances the accuracy of liver condition assessments, leading to more informed surgical planning.

In addition to evaluating LS, 2D-SWE also measures SPA, which serves as an indirect marker of portal hypertension. Portal hypertension is a significant predictor of PHLF, as it indicates increased pressure in the portal venous system, often associated with advanced liver disease and poor postoperative outcomes[5]. By integrating SPA measurements, 2D-SWE provides a comprehensive evaluation of the patient’s hepatic and splenic status, offering valuable insights into their risk profile for PHLF. This dual assessment capability makes 2D-SWE an invaluable tool in the preoperative setting, enhancing the ability to predict and mitigate potential complications[6].

Implications for clinical practice

The authors' work holds significant implications for clinical practice, offering a noninvasive method to enhance the precision of preoperative risk stratification for PHLF[4]. Integrating 2D-SWE into routine preoperative evaluation protocols could revolutionize clinical practice by improving the precision of risk stratification for PHLF[7]. Surgeons and hepatologists can utilize this technology to deepen their understanding of the patient's liver condition, enabling more tailored and strategic surgical approaches. This personalized care model is crucial for optimizing surgical techniques and postoperative management plans on the basis of the individual risk profile determined by 2D-SWE, leading to improved patient outcomes.

Furthermore, the noninvasive nature of 2D-SWE offers practical advantages in clinical settings. By reducing the need for invasive procedures and associated complications, 2D-SWE not only improves patient safety but also enhances the overall efficiency of preoperative assessments[8]. Accurate prediction of PHLF through noninvasive screening can enhance resource allocation and streamline patient care pathways, ultimately improving the overall quality of hepatic surgery services. As more clinicians integrate this technology, a significant shift towards more proactive and preventive surgical care strategies can be expected[9].

Future directions

While the current findings are promising, further research is needed to validate these results across larger and more diverse patient populations. Additionally, combining 2D-SWE with other diagnostic modalities may lead to more robust predictive models[10]. The continuous evolution of noninvasive technologies will undoubtedly play a pivotal role in shaping the future of hepatic surgery.

Conclusion

The adoption of 2D-SWE for evaluating LS and the SPA represents a significant advancement in the preoperative assessment of patients undergoing hepatic surgery. Its ability to predict PHLF noninvasively not only improves clinical outcomes but also enhances patient safety. As we continue to refine these techniques, the future of hepatic surgery looks promising, offering us more effective tools to address the challenges of liver disease.