Compared Of Different Indexes To Evaluat E Remnant Liver Volume In Predicting Post-hepatectomy Liver Failure

Objective: To compare the indexes to evaluate remnant liver volume(RLV),like residual liver volume to-total liver volume(RLV-TLV,%RLV),residual liver volume to standard liver volume(RLV/SLV),remnant liver volume-to-body weight ratio(RLV/BW),standard remnant liver volume(SRLV)in predicting postoperative liver failure in patients with hepatitis B virus(HBV)related hepatocellular carcinoma(HCC).Method: One hundred and eighty-one patients with HBV related hepatocellular carcinoma undergoing hemihepatectomy enrolled in study.Total functional liver volume,tumor volume,remnant liver volume,resected liver volume were measured by the Myrian-Liver surgical planning system before surgery.Intraoperative resected liver volume(include resected normal liver and tumor volume)were collected by drainage method.PHLF was diagnosed by 50e50 criteria and International Study Group of Liver Surgery(ISGLS)criteria,respectively.Using multivariate analysis to analyze the riskfactors of PHLF.Compared of %RLV,RLV/SLV,RLV/BW,SRLV with each other using the ROC curve analysis.Then according the cut-off of RLV to regroup,analyzing the complication in each group.Result: Using the logistic regression model,liver cirrhosis(HR: 0.002,95%CI:0-0.244,P = 0.012),RLV/SLV(HR:1.16×10205,95% CI: 6.007×1028-8.543×10428,P = 0.023),RLV/BW(HR: 2.58×1030,95% CI:9.546×107-6.971×1052,P = 0.008)and SRLV(HR:0,95% CI:0-0.010,P =0.022)were identified as independent predictors of PHLF in the group of 50e50 criteria.According the ISGLS criteria,intraoperative blood loss(HR : 1.001,95% CI: 1.000-1.002,P = 0.004)and SRLV(HR:0.985,95% CI: 0.971-0.999,P = 0.033)were identified as independent predictors of PHLF.In ROC curve analysis compared,it showed statistical significant in the comparison of RLV/SLV,SRLV with %RLV,RLV/BW(P <0.05)in the group of 50e50 criteria,while no statistical significant in RLV/SLV and SRLV.Maximum area under the curve occurred in SRLV and RLV/SLV(all 0.903).Cut-off of SRLV and RLV/SLV were 340ml/m~2 and 48%,respectively(sensitivity and specialty rate were 100% and 72.3%)in the group of 50e50 criteria.According the ISGLS criteria,SRLV were statistical significant compared with RLV/SLV and RLV/BW(P <0.05),but it showed no statistical significant in the comparison of %RLV with RLV/SLV,SRLV and RLV/BW.Maximum area under the curve occurred in SRLV(AUC=0.776,sensitivity and specialty rate were 64% and 88.7%).The cut-off of SRLV in ISGLS criteria is also340ml/m~2.In group of SRLV > 340 ml/m~2,38 case didn’t occur postoperative complications(32.8%);65 case were mild complications(56%);13 case were severe complications(11.2%).In group of SRLV ≤340 ml/m~2,1 case were no complications(1.5%);40 case were mild complications(61.5%);23 case were severe complications(35.4%);1 patient died of postoperative complication.It showed statistical significant in grades of complications compared group of SRLV >340 ml/m~2 with group of SRLV ≤ 340 ml/m~2(P<0.01).Result:%RLV,RLV/SLV,RLV/BW and SRLV all the effective indexes to predict PHLF.In conclusion,compared with %RLV,RLV/SLV and RLV/BW,SRLV is more sensitive,specific and stable in predicting PHLF.Patients with HBV fulfill an anticipated SRLV >340 ml/m~2 after hemihepatectomy,the risk of PHLF and severe postoperative complications increase.