Abstract
BackgroundThe purpose of this case series is to investigate the relationship between splenic thickness (ST) and postoperative outcomes after hepatic resection in hepatitis B virus (HBV)-associated hepatocellular carcinoma (HCC) patients.MethodsThe clinical data of 320 patients with HBV-associated HCC who had undergone liver resection were retrospectively analyzed. The value of ST in predicting postoperative outcomes was evaluated.ResultsA total of 320 patients were enrolled in the study. An increase in ST was significantly associated with an increase in portal vein diameter (PVD), indocyanine green retention rate 15 min (ICG R15), and total bilirubin (TBIL); however, it was negatively correlated with platelet count (PLT). Post-hepatectomy liver failure (PHLF) occurred in 35 (10.9%) patients. Multivariate logistic regression analysis showed that ST was an independent predictor of morbidity and mortality after hepatectomy. Meanwhile, ST was associated with an almost sixfold increased risk for developing perioperative complications (OR 5.678; 95% CI 2.873 to 11.224; P < 0.001) and almost 13-fold increased risk for mortality after hepatectomy (OR 13.007; 95% CI 1.238 to 136.627; P = 0.033).The area under the receiver operating characteristic (ROC) curve (AUC) of ST for predicting the incidence of PHLF was 0.754 (95% confidence interval (CI) 0.667 to 0.841; P < 0.001), with a sensitivity of 57.1% and a specificity of 82.5%, which were significantly greater than those of the ICG R15 level (AUC 0.670; 95% CI 0.560 to 0.779; P < 0.001). The critical value of ST was 43.5 mm.ConclusionsST, which is an easy, inexpensive, and routinely available perioperative marker, showed a favorable predictive value for postoperative outcomes in HBV-associated HCC patients.
Highlights
The purpose of this case series is to investigate the relationship between splenic thickness (ST) and postoperative outcomes after hepatic resection in hepatitis B virus (HBV)-associated hepatocellular carcinoma (HCC) patients
There was a significant difference in the incidence of Post-hepatectomy liver failure (PHLF) between patients with higher ICG Indocyanine green retention rate 15 min (R15) levels (≥ 7.95%) and those with lower indocyanine green retention rate 15 min (ICG R15) levels (< 7.95%), the results suggested that the predictive value of ST was better than that of ICG R15
PHLF post-hepatectomy liver failure, ST splenic thickness, ICG R15 indocyanine green retention rate 15 min Discussion Given that there is a high mortality associated with PHLF, there is an increased interest in identifying HCC patients who are at risk for hepatic dysfunction or failure at the preoperative stage
Summary
The purpose of this case series is to investigate the relationship between splenic thickness (ST) and postoperative outcomes after hepatic resection in hepatitis B virus (HBV)-associated hepatocellular carcinoma (HCC) patients. In Asia, approximately 80% of HCC cases occur in patients with cirrhosis derived from chronic HBV infection [7].These co-morbidities, along with portal hypertension [8], are associated with increased morbidity or mortality because of a significant impairment in liver function [9]. There is a need for preoperative spleen assessment during hepatic resection in HBV-associated HCC patients. This has resulted in the adoption of spleen size as a marker of the safety and prognosis of liver surgery [12,13,14]
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