Estimated remnant liver function prior to hepatectomy for CR metastasis is a better predictor of post-hepatectomy liver failure than APRI score.

Abstract

Background: Posthepatectomy liver failure (PHLF) is a major complication after hepatectomy with a high mortality rate. The future remnant liver volume (FLRV%) and the total liver function both influence the occurrence of PHLF. Total liver function can be reduced in chemotherapy associated liver injury (CALI). Different tools predicting PHLF have been described in hepatectomy for colorectal liver metastasis after chemotherapy. Aspartate aminotransferase to platelet ratio index (APRI) has been shown to predict CALI and PHLF related to severe CALI. Estimation of the future liver remnant function (eFLRF) in a formula combining 99mTc-Mebrofenin Hepatobiliary Scintigraphy (HBS) and FLRV% liver volumetry has been shown to predict PHLF. No direct comparison between eFLRF and APRI has been performed up to now. Methods: Estimation of the future liver remnant function (eFLRF) was performed in 140 patients prior to liver resection for colorectal liver metastasis after preoperative systemic therapy. When the cut-off for eFLRF was under 2.3%/min/m2, portal vein embolization or ligation was performed. APRI scores was calculated in all patients. Results: In ROC analysis, FLRV% and eFLRF had a better predictive value for PHLF than HBS alone and APRI. In multivariate analysis, eFLRF seems to be the only predicting factor for PHLF. Conclusion: PHLF is best predicted by combining volumetry with liver function in one formula than by separate volumetric or functional evaluation of the liver.