Evaluation of liver regeneration and post-hepatectomy liver failure after hemihepatectomy in patients with hepatocellular carcinoma

Abstract

Aim: To explore clinical factors associated with extent of liver regeneration after hemihepatectomy to treat hepatocellular carcinoma (HCC). Methods: Future liver remnant volume (as a percentage of functional liver volume, %FLRV) and remnant liver volume were measured preoperatively and at 1, 5, 9, and 13 weeks postoperatively. Results: After hepatectomy, 1 of 125 patients (0.8%) died within 3 months, 13 (10.4%) experienced liver failure, and 99 (79.2%) experienced complications. %FLRV was able to predict liver failure with an area under the receiver operating characteristic curve of 0.900, and a cut-off value of 42.7% showed sensitivity of 85.7% and specificity of 88.6%. Postoperative median growth ratio was 21.3% at 1 week, 30.9% at 5 weeks, 34.6% at 9 weeks, and 37.1% at 13 weeks. Multivariate analysis identified three predictors associated with liver regeneration: FLRV < 601 cm3, %FLRV, and liver cirrhosis. At postoperative weeks (POWs) 1 and 5, liver function indicators were significantly better among patients showing high extent of regeneration than among those showing low extent, but these differences disappeared by POW 9. Conclusions: FLRV, %FLRV, and liver cirrhosis strongly influence extent of liver regeneration after hepatectomy. %FLRV values below 42.7% are associated with greater risk of post-hepatectomy liver failure.

Preoperative evaluation of liver regeneration following hepatectomy in hepatocellular carcinoma using magnetic resonance elastography

“…Third, owing to the retrospective design, the postoperative CT follow-up interval was not maintained consistently in all patients. However, previous studies (51,52) have demonstrated that the first postoperative week is quantitatively critical during the liver regeneration process, and subsequent regeneration increases at a slower pace. Therefore, while the time interval in our study was within an acceptable range, additional prospective studies are required to standardize the follow-up interval to improve the results.…”

Enhanced Recovery After Surgery in the Patients With Hepatocellular Carcinoma Undergoing Hemihepatectomy

“…[20][21][22] Most HCC patients have a background of cirrhosis, and the morbidity of these patients undergoing hepatectomy remains high, close to 70% after major hepatectomy. 23,24 In ERAS protocols, some traditional perioperative care procedures such as overnight fasting and carbohydrate loading that were deleted to lessen the nutritional stress were speculated to be beneficial to HCC patients with cirrhosis. 25,26 Kaibori et al reported that ERAS program implementation could significantly shorten the operative time and postoperative hospital stay, and reduce the total volume infused during surgery in patients with HCC undergoing extended hepatectomy, which was defined as resection of more than 2 sections.…”

A Prospective Study of Liver Regeneration After Radiotherapy Based on a New (Su’S) Target Area Delineation

“…In the past, regarding the clinical practice of radiotherapy for liver cancer, more attention has been paid to the prevention and treatment of radiation-induced liver injury (13)(14)(15), but no indepth study on liver regeneration has been conducted. Liver regeneration after hepatectomy (16), associated with liver partition and portal vein ligation for staged hepatectomy (ALPPS) (17) and portal vein embolization (PVE) (18) were beneficial to the recovery of treatment-induced liver injury. With the gradual application of preoperative and postoperative radiotherapy for HCC (19)(20)(21)(22)(23), liver regeneration after radiotherapy will become a new focus of clinical attention for the prevention or recovery of radiation-induced liver damage.…”