Remnant liver volume-based predictors of postoperative liver dysfunction after hepatectomy: analysis of 625 consecutive patients from a single institution

Abstract

During hepatic resection, accurate estimation of remnant liver volume and hepatic function is crucial for avoiding postoperative liver failure. The purpose of this study was to identify preoperative factors related to postoperative liver dysfunction according to the percentage of future liver remnant volume (%FLR). A total of 625 patients who underwent hepatectomy were enrolled in this study. Total bilirubin level >50 μmol/L and/or prothrombin time index <50 % on postoperative day 5 were used as criteria for postoperative liver dysfunction (PLD). Patients were classified into 3 groups according to the %FLR: 35-60 (n = 116), 60-80 (n = 157), and >80 (n = 351). Multivariate logistic regression analysis was performed to identify factors related to postoperative liver dysfunction in each group. Among the patients with 35-80 %FLR, the morbidity and mortality rates were significantly higher in patients with PLD than in patients without PLD. There was no postoperative death in patients with >80 %FLR . Multivariate analysis showed that PLD was associated with receptor index (LHL15) ≤0.93 (odds ratio [OR] = 7.96) in patients with 35-60 %FLR. The sensitivity and specificity for PLD were 87.5 and 96.1 %, respectively. In patients with 60-80 %FLR, PLD was associated with platelet count <10.0 × 10(4)/mL (OR = 6.12). The sensitivity and specificity for PLD were 73.3 and 96.2 %, respectively. LHL15 ≤0.93 and platelet count <10.0 × 10(4)/mL are pivotal indicators for predicting PLD in patients with 35-60 %FLR and 60-80 %FLR, respectively.