1
|
Piccus R, Joshi K, Hodson J, Bartlett D, Chatzizacharias N, Dasari B, Isaac J, Marudanayagam R, Mirza DF, Roberts JK, Sutcliffe RP. Significance of predicted future liver remnant volume on liver failure risk after major hepatectomy: a case matched comparative study. Front Surg 2023; 10:1174024. [PMID: 37266000 PMCID: PMC10229890 DOI: 10.3389/fsurg.2023.1174024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 05/03/2023] [Indexed: 06/03/2023] Open
Abstract
Introduction Future liver remnant volume (FLRV), a risk factor for liver failure (PHLF) after major hepatectomy (MH), is not routinely measured. This study aimed to evaluate the association between FLRV and PHLF. Patients and methods All patients undergoing MH (4 + segments) between 2011 and 2018 were identified from a prospectively maintained single-centre database. Perioperative data were collected for patients with PHLF, who were matched (1:2) with non-PHLF controls. FLRV and FLRV% (i.e., % of total liver volume) were calculated retrospectively from preoperative CT scans using Synapse-3D software, and compared between the PHLF and matched control groups. Results Of 711 patients undergoing MH, PHLF occurred in 27 (3.8%), of whom 24 had preoperative CT scans available. These patients were matched to 48 non-PHLF controls, 98% of whom were classified as being at high risk of PHLF on preoperative risk scoring. FLRV% was significantly lower in the PHLF group, compared to matched controls (median: 28.7 vs. 35.2%, p = 0.010), with FLRV% < 30% in 58% and 29% of patients, respectively. Assessment of the ability of FLRV% to differentiate between PHLF and matched controls returned an area under the ROC curve of 0.69, and an optimal cut-off value of FLRV% < 31.5%, which yielded 79% sensitivity and 67% specificity. Conclusions FLRV% is significantly predictive of PHLF after MH, with over half of patients with PHLF having FLRV% < 30%. In light of this, we propose that all patients should undergo risk stratification prior to MH, with the high risk patients additionally being assessed with CT volumetry.
Collapse
Affiliation(s)
- R. Piccus
- University of Birmingham, Birmingham, United Kingdom
| | - K. Joshi
- University of Birmingham, Birmingham, United Kingdom
- Liver Unit, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - J. Hodson
- Institute of Translational Medicine, Queen Elizabeth Hospital, Birmingham, United Kingdom
- Department of Health Informatics, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - D. Bartlett
- Liver Unit, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | | | - B. Dasari
- University of Birmingham, Birmingham, United Kingdom
- Liver Unit, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - J. Isaac
- Liver Unit, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - R. Marudanayagam
- Liver Unit, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - D. F. Mirza
- Liver Unit, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - J. K. Roberts
- University of Birmingham, Birmingham, United Kingdom
- Liver Unit, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - R. P. Sutcliffe
- University of Birmingham, Birmingham, United Kingdom
- Liver Unit, Queen Elizabeth Hospital, Birmingham, United Kingdom
| |
Collapse
|
2
|
Nutu A, Wilson M, Ross E, Joshi K, Sutcliffe R, Roberts K, Marudanayagam R, Muiesan P, Chatzizacharias N, Mirza D, Isaac J, Dasari BVM. Influence of middle hepatic vein resection during right or left hepatectomy on post hepatectomy outcomes. Ann Hepatobiliary Pancreat Surg 2022; 26:257-262. [PMID: 35599354 PMCID: PMC9428431 DOI: 10.14701/ahbps.21-159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 01/24/2022] [Accepted: 02/04/2022] [Indexed: 11/17/2022] Open
Abstract
Backgrounds/Aims Middle hepatic vein (MHV) is usually preserved as a part of the right or left hepatectomy in order preserve the venous outflow of remnant liver. The aim of this study was to evaluate if resection of MHV could influence post-resection outcomes of standard right or left hepatectomy. Methods Patients who underwent standard right or left hepatectomy between January 2015 and December 2019 were included. Anatomical remnant liver volumes were measured retrospectively using the Hermes workstation (Hermes Medical Solutions AB, Stockholm, Sweden). Uni- and multi-variate analyses were performed to assess the difference in outcomes of those with preservation of MHV and those without preservation. Results A total of 144 patients were included. Right hepatectomy was performed for 114 (79.2%) and left hepatectomy was performed for 30 (20.8%) patients. MHV was resected for 13 (9.0%) in addition to the standard right or left hepatectomy. Median remnant liver volume was significantly higher in the MHV resected group (p < 0.01). There was no significant difference in serum level of bilirubin, international normalized ratio, alanine aminotransferase, creatinine on postoperative day 1, 3, 5, or 10, ≥ grade IIIa complications (p = 0.44), or 90-day mortality (p = 0.41). On multivariable analysis, resection of the MHV did not influence the incidence of post hepatectomy liver failure (p = 0.52). Conclusions Resection of the MHV at standard right or left hepatectomy did not have a negative impact on postoperative outcomes of patients with adequate remnant liver volume.
Collapse
Affiliation(s)
- Anisa Nutu
- Department of Hepato-Biliary and Pancreatic and Liver Transplantation, Queen Elizabeth Hospital, Birmingham, UK
| | - Michael Wilson
- Department of Nuclear Medicine, Queen Elizabeth Hospital, Birmingham, UK
| | - Erin Ross
- Department of Nuclear Medicine, Queen Elizabeth Hospital, Birmingham, UK
| | - Kunal Joshi
- Department of Hepato-Biliary and Pancreatic and Liver Transplantation, Queen Elizabeth Hospital, Birmingham, UK
| | - Robert Sutcliffe
- Department of Hepato-Biliary and Pancreatic and Liver Transplantation, Queen Elizabeth Hospital, Birmingham, UK
| | - Keith Roberts
- Department of Hepato-Biliary and Pancreatic and Liver Transplantation, Queen Elizabeth Hospital, Birmingham, UK
| | - Ravi Marudanayagam
- Department of Hepato-Biliary and Pancreatic and Liver Transplantation, Queen Elizabeth Hospital, Birmingham, UK
| | - Paolo Muiesan
- Department of Hepato-Biliary and Pancreatic and Liver Transplantation, Queen Elizabeth Hospital, Birmingham, UK
| | - Nikolaos Chatzizacharias
- Department of Hepato-Biliary and Pancreatic and Liver Transplantation, Queen Elizabeth Hospital, Birmingham, UK
| | - Darius Mirza
- Department of Hepato-Biliary and Pancreatic and Liver Transplantation, Queen Elizabeth Hospital, Birmingham, UK
| | - John Isaac
- Department of Hepato-Biliary and Pancreatic and Liver Transplantation, Queen Elizabeth Hospital, Birmingham, UK
| | - Bobby V. M. Dasari
- Department of Hepato-Biliary and Pancreatic and Liver Transplantation, Queen Elizabeth Hospital, Birmingham, UK
| |
Collapse
|
3
|
Yu T, Ye X, Wen Z, Zhu G, Su H, Han C, Huang K, Qin W, Liao X, Yang C, Liu Z, Wang X, Xu B, Su M, Lv Z, Lau WY, Peng T. Intraoperative Indocyanine Green Retention Test of Left Hemiliver in Decision-Making for Patients With Hepatocellular Carcinoma Undergoing Right Hepatectomy. Front Surg 2021; 8:709017. [PMID: 34604294 PMCID: PMC8484520 DOI: 10.3389/fsurg.2021.709017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 07/07/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: The aim of this study was to select qualified patients with hepatocellular carcinoma (HCC) who underwent right hepatectomy (RH) via intraoperative indocyanine green retention test at 15 min (ICG-R15) of the left hemiliver, which prevents severe posthepatectomy liver failure (PHLF). Methods: Twenty HCC patients who were preoperatively planned to undergo RH were enrolled. Intraoperative ICG-R15 of left hemiliver was measured after the right Glissonean pedicle was completely blocked. Patients then underwent RH if intraoperative ICG-R15 was ≤ 10%. Otherwise, patients underwent staged RH (SRH), either associating liver partitioning and portal vein ligation for staged hepatectomy (ALPPS) or portal vein ligation (PVL), followed by stage-2 RH. The comparison group consisted of patients with a ratio of standard left liver volume (SLLV) of > 40% and preoperative ICG-R15 ≤ 10% who underwent RH. The clinical outcomes of these two groups were compared. Results: Of the 20 patients, six underwent stage-1 RH, six underwent ALPPS, five underwent PVL followed by stage-2 RH, and three failed to proceed to stage-2 RH after PVL. No significant differences were found among the 17 patients who underwent stage-1 or stage-2 RH in the study group, the 19 patients in the comparison group, the 11 patients in the stage-2 RH group, and the six patients in the stage-1 RH group in incidences of PHLF, postoperative complications, hospital stay, and HCC recurrence within 1 year after RH. Compared with the stage-1 ALPPS group, the mean operative time and blood loss of the stage-1 PVL group were significantly less (p <0.001 and p = 0.022, respectively). The stage-1 PVL group had a significantly longer waiting-time (43.4 vs. 14.0 days, p = 0.016) than the stage-1 ALPPS group to proceed to stage-2 RH. After stage-2 RH, tumor recurrence within 1 year was 20% (1/5) in patients after PVL and 50% (3/6) after stage-1 ALPPS. Conclusions: Intraoperative ICG-R15 ≤ 10% of left hemiliver was valuable in intraoperative decision-making for patients who were planned to undergo RH. There is a possibility that stage-1 PVL might help to select patients with more favorable biological behavior to undergo stage-2 RH.
Collapse
Affiliation(s)
- Tingdong Yu
- Department of Hepatobiliary Surgery, the First Affiliated Hospital of Guangxi Medical University, Nanning, China.,Department of Hepatobiliary Surgery, the Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Xinping Ye
- Department of Hepatobiliary Surgery, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Zhang Wen
- Department of Hepatobiliary Surgery, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Guangzhi Zhu
- Department of Hepatobiliary Surgery, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Hao Su
- Department of Hepatobiliary Surgery, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Chuangye Han
- Department of Hepatobiliary Surgery, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Ketuan Huang
- Department of Hepatobiliary Surgery, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Wei Qin
- Department of Hepatobiliary Surgery, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xiwen Liao
- Department of Hepatobiliary Surgery, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Chengkun Yang
- Department of Hepatobiliary Surgery, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Zhen Liu
- Department of Hepatobiliary Surgery, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xiangkun Wang
- Department of Hepatobiliary Surgery, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Banghao Xu
- Department of Hepatobiliary Surgery, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Ming Su
- Department of Hepatobiliary Surgery, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Zili Lv
- Department of Pathology, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Wan Yee Lau
- Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Tao Peng
- Department of Hepatobiliary Surgery, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| |
Collapse
|