Analysis Of Clinical Factors Affecting Early And Late Regeneration Of The Liver After Anatomical Hepatectomy

Objective: Regeneration of remnant liver tissue after hepatectomy plays an important role in preventing the development and progression of postoperative liver failure.In this study,we used our self developed computer assisted surgical system(Hisense computer assisted surgery system,Hisense CAS)to perform three dimensional reconstruction of preoperative and postoperative liver and to observe and analyze the degree of regeneration of remnant liver in patients who underwent anatomical hepatectomy for hepatobiliary tumors in different postoperative periods.To investigate the factors influencing liver regeneration after hepatectomy.Methods: Patients who underwent anatomical hepatectomy for hepatobiliary tumors from January 2014 to December 2020 in the Department of Hepatobiliary and Pancreatic Surgery,Affiliated Hospital of Qingdao University were selected,and 187 patients with preoperative enhanced CT,postoperative CT examinations in January and June and complete clinical data were included in the study.Hisense CAS was used to perform 3D reconstruction and simulated resection of the liver on patients’ CT examinations,measure the total liver volume,tumor volume,remnant liver volume,and liver volume at 1 month and 6 months after hepatectomy,calculate the regeneration rate of remnant liver volume at1 month and 6 months after surgery,and subject the predictive factors that may affect liver regeneration after hepatectomy in the perioperative period to univariate and multifactor analyses to investigate the significant factors affecting liver regeneration after hepatectomy.Results: 1.A total of 187 patients with hepatobiliary tumors were included,including128 patients with hepatocellular carcinoma,27 patients with intrahepatic cholangiocarcinoma,21 patients with hilar cholangiocarcinoma,5 patients with liver metastases from colorectal cancer,and 6 patients with intraductal papilloma,and there was no significant difference in pathological typing between the high regeneration and low regeneration groups(P=0.057).The median liver regeneration rates of all patients were24.3% and 38.3% at 1 and 6 months postoperatively,respectively.The median liver regeneration rates in the right hemicolectomy group were 40.0% and 69.3% at 1 and 6months postoperatively,respectively;the median liver regeneration rates in the right posterior lobectomy group were 15.6% and 28.4% at 1 and 6 months postoperatively,respectively;the median liver regeneration rates in the right anterior lobectomy group were19.7% and 34.0% at 1 and 6 months postoperatively,respectively;the median liver regeneration rates in the left hemicolectomy group were The median liver regeneration rates in the left hemicolectomy group were 17.9% and 47.4% at 1 month and 6 months after surgery,respectively;and the median liver regeneration rates in the left lobectomy group were 9.9% and 26.7% at 1 month and 6 months after surgery,respectively.The differences in median liver regeneration rates between the groups at 1 month and 6 months after surgery were statistically significant(P<0.001).2.Correlation analysis showed that the standard remnant liver volume was negatively correlated with the liver regeneration rate at 1 month after surgery(r= 0.626,P<0.001);meanwhile,the standard remnant liver volume was negatively correlated with the liver regeneration rate at 6 months after surgery(r= 0.696,P<0.001).3.Univariate analysis showed statistically significant gender difference(P<0.001),history of alcohol consumption(P<0.001),presence of cirrhosis(P<0.001),standard remnant liver volume(P<0.001),postoperative 5 day ALT(P=0.028),and postoperative 5day PLT(P=0.021)between the high regeneration and low regeneration groups(P<0.05).4.Multifactorial logistic regression analysis revealed that standard remnant liver volume(OR=1.014,95%CI: 1.009 1.018,P<0.001)and cirrhosis(OR=3.838,95%CI:1.633 9.021,P=0.002)were independent risk factors affecting liver regeneration after hepatectomy for hepatobiliary tumors.In addition,long term alcohol consumption(OR=2.319,95%CI:0.946～5.682,P=0.066)was a borderline predictor of liver regeneration.Conclusion: Cirrhosis and SRLV are independent risk factors affecting liver regeneration after hepatectomy for hepatobiliary tumors.These factors should be fully considered preoperatively,the anatomical relationship between the tumor and intrahepatic vasculature should be fully evaluated,the resectability of the tumor and the best resection mode should be clarified,and RLV and surgical risks should be evaluated by simulated hepatectomy to further improve the safety of surgery,reduce postoperative complications,and prolong patient survival.