Prediction of postoperative complications after hepatectomy using the fibroscan

Abstract

Background: Most of the postoperative complications that may occur after hepatectomy are related to the underlying liver background, and the common preoperative tests do not completely predict such complications. Transient elastography by Fibroscan is used to calculate the stiffness and the steatosis of the liver, and it may be also used to predict postoperative complications after hepatectomy. Methods: A prospective cohort study on consecutive patients scheduled for hepatectomy was planned. Fibroscan was performed during the preoperative workup. Accuracy of the liver stiffness and steatosis measured by Fibroscan in predicting the presence of cirrhosis, of steatosis, and the development of postoperative complications was assessed by ROC curve, and multivariate analysis. Results: Among 240 consecutive patients, 67 (28%) developed complications. ROC analysis identified patients with a stiffness equal or higher than 9.7 kPa (AUC = 0.728; sensitivity = 88.9%; specificity = 67.3%; P = 0.031), and a steatosis equal or higher than 250 dB/m/MHz (AUC = 0.656; sensitivity = 80%; specificity = 60%; P = 0.045) as those at greater risk of complications. Multivariate analysis found that elevated stiffness (OR = 3.45; P = 0.001), esophageal varices (OR = 2.98; P = 0.002), major resections (OR = 3.01; P = 0.001), and blood loss more than 500 ml (OR = 1.97; P = 0.002) were independent predictors of complications. Conclusions: Fibroscan is an easy, simple and valid instrument to measure the liver stiffness and steatosis, which values may be used to predict the occurrence of complications after hepatectomy.