Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Mar 16, 2021; 9(8): 1793-1802
Published online Mar 16, 2021. doi: 10.12998/wjcc.v9.i8.1793
Risk factors for post-hepatectomy liver failure in 80 patients
Ying Xing, Zheng-Rong Liu, Wei Yu, Hong-Yi Zhang, Mao-Min Song
Ying Xing, Zheng-Rong Liu, Wei Yu, Hong-Yi Zhang, Mao-Min Song, Department of General Surgery, Tiantan Hospital, Beijing 100170, China
Author contributions: Xing Y was involved in patient treatment, statistical analysis, writing of the original draft, and critical revision of the manuscript; Yu W took part in the statistical analysis; Liu ZR was involved in inpatient treatment; Zhang HY took part in the study conception, design, and critical revision of the manuscript; Song MM was involved in the study conception, design, writing of the original draft, and critical revision of the manuscript; all authors have read and approved the final manuscript.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee Approval Document of Tiantan Hospital, Institutional Review Board Approval No. KYSQ 2020-177-01.
Informed consent statement: All study participants provided written informed consent prior to study enrollment.
Conflict-of-interest statement: We do not have any patents, whether planned, pending or issued, broadly relevant to the work.
Data sharing statement: No additional data are available.
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: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mao-Min Song, MD, Chief Doctor, Professor, Surgical Oncologist, Department of General Surgery, Tiantan Hospital, No. 119 Fanyang Street, Beijing 100170, China. chongshuyong@126.com
Received: September 19, 2020
Peer-review started: September 19, 2020
First decision: December 13, 2020
Revised: December 21, 2020
Accepted: December 27, 2020
Article in press: December 27, 2020
Published online: March 16, 2021
Abstract
BACKGROUND

Post-hepatectomy liver failure (PHLF) is a serious complication and a leading cause of death after hepatectomy, an accurate prediction of PHLF is important for improvement of prognosis after hepatectomy.

AIM

To retrospectively analyze the risk factors for postoperative liver failure in patients undergoing hepatectomy for liver tumors.

METHODS

The clinical data of 80 patients undergoing hepatectomy in our hospital from June 2018 to January 2020 were collected. With laboratory examination as well as pre- and post-operative abdominal three-dimensional reconstructive computed tomography, the demographic data, surgical data, biochemical indicators, coagulation index, routine blood tests, spleen and liver volumes, relative remnant liver volume, and other related indicators were obtained and compared between patients with PHLF and those without PHLF.

RESULTS

PHLF occurred in 19 (23.75%) patients. Univariate logistic regression analysis showed that gender, history of hepatitis/cirrhosis, and preoperative bilirubin, albumin, coagulation function, albumin-bilirubin ratio, aspartate amino-transferase-to-platelet ratio index (APRI), Model for End-Stage Liver Disease score, spleen volume (SV), spleen volume/liver volume ratio (SV/LV), and relative remnant liver volume were statistically associated with the occurrence of PHLF (all P < 0.05). Multivariate regression analysis showed that preoperative total bilirubin, platelets (PLT), APRI, and SV/LV were independent risk factors for PHLF (all P < 0.05). The area under the curve and cut-off values were 0.787 and 18.6 mmol/L for total bilirubin, 0.893 and 146 × 1012/L for PLT, 0.907 and 0.416 for APRI, and 0.752 and 20.84% for SV/LV, respectively.

CONCLUSION

For patients undergoing liver resection, preoperative total bilirubin, PLT, APRI, and SV/LV are independent risk factors for PHLF. These findings may provide guidance to safely perform liver surgery in such patients.

Keywords: Hepatectomy, Liver failure, Liver tumors, Risk factors

Core Tip: The etiology of post-hepatectomy liver failure (PHLF) is unclear. The volume of liver resection and the liver functional reserve are mainly used to evaluate the risk of PHLF. In this study we explored the risk factors for PHLF in patients with liver tumors. We found that preoperative total bilirubin, platelets, aspartate amino-transferase-to-platelet ratio index, and spleen volume/liver volume ratio are independent risk factors for PHLF. Both biochemical results and spleen volume on imaging should be considered before establishing a surgical plan to minimize the risk of PHLF. These findings may provide guidance to safely perform liver surgery in such patients.