Risk factors of posthepatectomy liver failure for perihilar cholangiocarcinoma

Abstract

Background Surgery for perihilar cholangiocarcinoma (PHCC) is associated with high morbidity. This study aimed to investigate the clinical value of the future liver remnant volume‐to‐body weight (FLRV/BW) and propose a risk score for predicting the risk of patients with PHCC developing posthepatectomy liver failure (PHLF). Methods This study included 348 patients who underwent major hepatectomy with bile duct resection for PHCC during 2008‐2015 at a single center in Korea and they were retrospectively analyzed. Results Clinically relevant PHLF was noted in 40 patients (11.4%). The area under the curve (AUC) for FLRV/BW was not significantly different from that for FLRV/total liver volume (P = .803) or indocyanine green clearance of the future liver remnant (P = .629) in terms of predicting PHLF. On multivariate analysis, predictors of PHLF (P < .05) were male sex, albumin less than 3.5 g/dL, preoperative cholangitis, portal vein resection, FLRV/BW less than 0.5%, and FLRV/BW 0.5% to 0.75%. These variables were included in the risk score that showed good discrimination (AUC, 0.853; 95% CI, 0.802‐0.904). It will help rank patients into three risk subgroups with a predicted liver failure incidence of 4.75%, 18.73%, and 51.58%, respectively. Conclusions FLRV/BW is a comparable risk prediction factor of PHLF and the proposed risk score can help to predict the risk of planned surgery in PHCC.

A Bibliometric Analysis of the Role of 3D Technology in Liver Cancer Resection

“…The top three productive authors were: Fang CH, Yang J and Xiang N (Supplementary Table S3). Residual liver volume (RLV) is considered the most important predictor of liver failure after hepatectomy [44]. And this article proved that liver planning software, which provided 3D visualization and measurement of structures of interest in the liver, could accurately predict RLV after hepatectomy [20].…”

“…“Liver planning software accurately predicts postoperative liver volume and measures early regeneration” published by Simpson AL in 2014, had the highest citation count and centrality. Residual liver volume (RLV) is considered the most important predictor of liver failure after hepatectomy [44]. And this article proved that liver planning software, which provided 3D visualization and measurement of structures of interest in the liver, could accurately predict RLV after hepatectomy [20].…”

Predictive Factors for Post-Hepatectomy Liver Failure in Patients with Cholangiocarcinoma

“…PHLF is defined by deterioration in the ability of the liver to perform its previous functions after surgery due to the imbalance created in the circulation system of the remnant liver (Tsoris and Marlar, 2022). Previous studies revealed various factors associated with PHLF, including gender, age, comorbidities, malnutrition, cholangitis, cirrhosis, neoadjuvant (Sultana et al, 2018), abnormal liver function tests such as serum bilirubin levels, albumin, alkaline phosphatase (ALP), alanine transaminase (ALT), aspartate transaminase (AST), coagulation values: prothrombin time levels (PT) , international normalized ratio (INR) (Rahbari et al, 2011;Lee et al, 2020), type of liver resection, and future liver remnant. The International Study Group of Liver Study (ISGLS) defines PHLF as loss of liver function after liver resection for five days along with increase of serum bilirubin and coagulation levels higher than the standard value .…”

“…CCA patients with PHLF experience a prolonged length of hospital stay in intensive care unit, increased in-hospital mortality, and 90-day mortality (Arisaka et al, 2020;Lee et al, 2020). Identifying the risk factors of PHLF in CCA patients can improve post-liver resection outcomes.…”

“…Tumor size, serum bilirubin levels, neutrophil-to-lymphocyte ratio, and cancer antigen 19-9 level were reported as risk factors associated with PHLF in the aforementioned study (Sasaki et al, 2016). Lee et al, in their study on patients with perihilar CCA found that future liver remnant/body weight (FLR/BW) and portal vein resection could act as predictors of PHLF (Lee et al, 2020). Ishii et al, identified preoperative type IV collagen 7S as a significant independent factor associated with both PHLF and postoperative long-term recovery of liver function (Ishii et al, 2020).…”