The predictive value of future liver remnant function after liver resection for HCC in noncirrhotic and cirrhotic patients
The predictive value of future liver remnant function after liver resection for HCC in noncirrhotic and cirrhotic patients
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DOI：
10.1016/j.hpb.2018.11.012
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发表时间：
2019-07-01
期刊：
影响因子：
2.9
通讯作者：
Malinowski, Maciej
中科院分区：
文献类型：
--
作者：
Bluethner, Elisabeth;Jara, Maximilian;Malinowski, Maciej
背景：潜在肝病患者的外科手术仍有较高的术后并发症发生率，尤其是术后肝功能衰竭(PHLF)，从1.2%到33.8%不等。本研究的目的是探讨体积/功能分析在预测肝细胞癌患者肝切除相关并发症中的预后价值。方法：对2001-2014年间261例肝细胞癌切除患者的临床病理资料进行分析。以Limax检验为基础，回顾性获得未来肝残存体积(FLRV)和未来肝残存功能(FLRF)。对肝功能受损的高危患者进行亚组分析。对主要并发症的危险因素进行单因素和多因素回归分析，定义为Dindo>；=IIIb和PHLF分级=B。结果：在所有队列中，FLRF与主要并发症独立相关。FLRV、切除的肝体积和FLRF是PHLF的独立危险因素。在对高危患者的亚组分析中，FLRF被确定为主要并发症和PHLF发生的唯一独立危险因素。讨论：这些结果表明，在预测慢性肝病患者术后并发症和PHLF方面，FLRF优于FLRV。
Background: Surgical procedures in patients with underlying liver disease are still burdened by a high rate of postoperative morbidity, especially posthepatectomy liver failure (PHLF), ranging from 1.2 to 33.8%. The aim of this study was to investigate the prognostic value of volume/function analysis for the prediction of hepatectomy-related morbidity in patients with hepatocellular carcinoma.Methods: Clinicopathological data were analysed in 261 patients who underwent liver resection for HCC between 2001 and 2014. Future liver remnant volume (FLRV) and future liver remnant function (FLRF) based on LiMAx test were obtained retrospectively. A subgroup analysis for high-risk patients with impaired liver function was conducted. Univariate and multivariate regression analysis was performed to identify risk factors for major complications, defined by Dindo >= IIIb and PHLF grade >= B.Results: In the total cohort, FLRF was independently associated with major complications. FLRV, resected liver volume, and FLRF were independent risk factors for PHLF. In a subgroup analysis of high-risk patients, FLRF was identified as the only independent risk factor for major complications and PHLF development.Discussion: These results suggest the superior value of FLRF to FLRV in predicting postoperative complications as well as PHLF in patients with chronic liver disease.