Investigating the Relationship Between Preoperative Computed Tomography-Calculated Future Liver Remnant and the Incidence of Post-Hepatectomy Liver Failure
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Abstract
Background: Hepatectomy is a treatment for early-stage liver cancer; however, post-hepatectomy liver failure is a significant complication associated closely with a reduction in residual liver volume. Nowadays, advancements in technology, particularly computerized tomography, facilitate the accurate calculation of the future liver remnant. This capability is applicable for the preoperative assessment of patients undergoing hepatectomy procedures.
Objective: To investigate the association between preoperative future liver remnant, calculated by computerized tomography, and the incidence of post-hepatectomy liver failure.
Methods: In this retrospective study, we analyzed information from the electronic medical records of patients who underwent hepatectomy at Chiangrai Prachanukroh Hospital between January 2018 and April 2021. The dataset included details such as future liver remnant and factors associated with post-hepatectomy liver failure. The analysis employed the methodology of multivariable logistic regression.
Results: Fifty patients were included in the study, with post-hepatectomy liver failure observed in 10 cases. The mean future liver remnant in patients with post-hepatectomy liver failure was significantly lower than in those without (35.87% vs. 66.41%, p ≤ 0.001). The cut-point value for future liver remnant at 45.94% demonstrated the highest sensitivity and specificity for predicting post-hepatectomy liver failure (sensitivity 90% and specificity 87.5%). Patients with a future liver remnant less than 45.94% experienced a markedly elevated risk of post-hepatectomy liver failure, with an adjusted odds ratio of 60.72 (95% CI 2.72-1,352.00, p = 0.009).
Conclusions and recommendations: The assessment of patients and the calculation of future liver remnant through computerized tomography before hepatectomy are crucial and have the potential to reduce the mortality rate. In cases where patients exhibit a future liver remnant less than 45.94%, proactive measures such as portal vein embolization or portal vein ligation should be considered before surgery to augment the future liver remnant. If patients have future liver remnant less than 45.94%, portal vein embolization or portal vein ligation should be performed before surgery to increase future liver remnant.
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