| Hepatectomy is the one of the most effective ways to provide long-term survival for patients with hepatocellular carcinoma (HCC) and other diseases. However, safety is always one of the primary concerns before conducting this operation, especially in patients with a large tumor, which usually requires a major resection (>3segments). Moreover, it is even more important to evaluate liver function because80%of patients with HCC are associated with liver cirrhosis. Liver function reserve determined by Child-Pugh score and future liver volume (FLV) based on computer tomography is an important approach to assess the risk of liver failure after major liver resection. Although several studies have showed30-40%FLV is necessary when the liver is either non-cirrhotic or cirrhotic, the safety limit of FLV remains controversial. But in china, most of the HCC patients are complicated with liver cirrhosis, which must be concerned while assessing the safety of operation. To be realistic, we didn’t exclude patients with liver cirrhosis. Hemi-hepatectomy is commonly carried out in patients encountered large tumors, and the transection line is more definite during operation and pre-operative plan in CT scan, so we focused on patients undergoing hemi-hepatectomy. We conducted a retrospective analysis to determine a safe FLV in patients who underwent left or right hemi-hepatectomy. Our findings include:1. We employed a standardized future liver volume (SFLV) to minimize the individual difference, SFLV is FLV to body surface area (BSA) ratio. Univariate analysis showed that SFLV is one of the risk factors of PLD, difference between SFLV of PLD patients and no PLD patients is statistically significant. The results of multivariate analysis showed only SFLV is an independent risk factor to predict PLD.2. Receiver operator characteristic (ROC) analysis showed that patients with a SFLV value less than300.54ml/m2associated with a higher risk of PLD, and by using this value we can predict PLD in patients undergoing hemi-hepatectomy with79.6%sensitivity and70.0%specificity.3. As representative factors to show the injury by partial liver resection, the changes of prothrombin time (PT) and total serum bilirubin (TB) between pre-operative test and post-operative Day1test were also taken into account, we evaluated factors associated with these changes. The multi-variant analysis showed only SFLV was an independent factor for this change.Conclusions. We have shown that SFLV can predict PLD, and identified a SFLV of300.54ml/m2as the safety limit with a good sensitivity and specificity. These results can help us to assess patients’pre-operative liver function reserve, making an appropriate decision. In the following clinical practice, a SFLV of300.54ml/m2can be used as an indication, operations on patients whose SFLV is below this safety limit should be taken seriously.The potential application of this work1. Several studies have showed FLV can predict PLD, while the patients included usually have non-cirrhotic livers. But in china, most of the HCC patients are complicated with liver cirrhosis, results of those studies don’t have much application. To be realistic, the ratio of cirrhotic patients in our study is very big.2. We found that the FLV to total liver volume ratio usually overestimated the liver function in cirrhotic patients, which means that the safety limit in previous studies may not be suitable for cirrhotic patients. SFLV is a good approach to assess liver function reserve in cirrhotic patients.3. We have identified a SFLV of300.54ml/m2as the safety limit with a good sensitivity and specificity. These results can help us to assess patients’pre-operative liver function reserve, making an appropriate decision.Originalities of this work1. The patients in previous studies usually have non-cirrhotic livers. To be realistic, the ratio of cirrhotic patients in our study is very big, so the safety limit of SFLV has a wide range of use.2. The definitions of PLD in previous studies were various, Child-Pugh score is one of the most popular methods to measure liver function. In our study, PLD was defined when post-operative liver function was classified as Child C (Child-Pugh score>10), which can comprehensively reflect post-operative liver function, as we know, it is used as an end-point for the first time.3. Hemi-hepatectomy is commonly carried out in patients encountered large tumors, and the transection line is more definite during operation and pre-operative plan in CT scan, so we focused on patients undergoing hemi-hepatectomy. |
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