Abstract
BackgroundTo determine the standard remnant liver volume (SRLV) threshold to avoid postoperative hepatic insufficiency inpatients in different stages of hepatic fibrosis who undergo right hemi-hepatectomy.MethodsData for 85 patients at our single medical center were analysed prospectively to examine whether the following factors differed significantly between those who experienced postoperative hepatic insufficiency and those who did not: height, prothrombin time, remnant liver volume, SRLV or hepatic fibrosis stage.ResultsLogistic regression showed SRLV and hepatic fibrosis stage to be independent risk factors for postoperative hepatic insufficiency. The threshold SRLV for predicting insufficiency was 203.2 ml/m2 across all patients [area under receiver operating characteristic curve (AUC) 0.778, sensitivity 66.67%, specificity 83.64%, p<0.0001), 193.8 ml/m2 for patients with severe hepatic fibrosis (AUC 0.938, sensitivity 91.30%, specificity 85.71%, p<0.0001), and 224.3 ml/m2 for patients with cirrhosis (AUC 0.888, sensitivity 100%, specificity 64.29%, p<0.0001).ConclusionsRight hemi-hepatectomy may be safer in Chinese patients when the standard remnant liver volume is more than 203.2 ml/m2 in the absence of hepatic fibrosis or cirrhosis, 193.8 ml/m2 in the presence of severe hepatic fibrosis or 224.3 ml/m2 in the presence of cirrhosis.
Highlights
To determine the standard remnant liver volume (SRLV) threshold to avoid postoperative hepatic insufficiency inpatients in different stages of hepatic fibrosis who undergo right hemi-hepatectomy
Patients matching the following criteria were enrolled: (1) right-half liver resection; (2) single or multiple tumours confined to the right hepatic lobe, which was confirmed as Hepatocellular carcinoma (HCC) based on postoperative pathology; (3) all liver tomography and enhancement tests were performed within one week before hepatectomy; and (4) complete pre, intra- and postoperative clinical data
We present here threshold values for different subpopulations of HCC patients with cirrhosis or fibrosis after right hemi-hepatectomy, which tends to remove a larger proportion of total liver volume
Summary
To determine the standard remnant liver volume (SRLV) threshold to avoid postoperative hepatic insufficiency inpatients in different stages of hepatic fibrosis who undergo right hemi-hepatectomy. Zhang et al BMC Surg (2021) 21:57 reported that SRLV < 250 mL / m2 is associated with significantly higher risk of hepatic insufficiency than higher SRLV [8], other studies have reported different thresholds [7]. There is no consensus on an SRLV threshold for postoperative hepatic insufficiency. Determining such a threshold may contribute to patient safety, especially in right hemi-hepatectomy, since the right half of the liver accounts for about 60–75% of the total liver volume [9], meaning greater risk that tissue removal will leave behind insufficient remnant liver
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