Background: An adequate future liver remnant volume (FLRV%) reduces the risk of post-hepatectomy liver failure (PHLF). This study evaluates 1) the association of FLRV% with grade 4/5 morbidity and 2) the safe FLRV% threshold for PHLF- and non-PHLF-related major morbidity.
Study design: Patients undergoing major hepatectomy for malignancy from 2000-2020 were included. FLRV%, morbidity and cause (PHLF- or non-PHLF-related) were determined; patients were stratified by normal (NL) or impaired livers (IL). The relationship between FLRV% and both all-cause and PHLF-related grade 4/5 morbidity was analyzed. The data were then randomly divided into training and testing cohorts to validate a safe FLRV% threshold.
Results: 1,748 patients were included: 70% had metastatic liver cancer, 42% underwent right hepatectomy. Median FLRV% was 42% (range:16-90%). Overall morbidity was 51%. Grade 4/5 morbidity was 3.2%: 28 (50%) PHLF-related and of these, 26 (26/28,92.9%) were fatal. There was a significant association between FLRV% and grade 4/5 PHLF-related morbidity. For every 10% increase in FLRV%, the odds of grade 4/5 PHLF-related morbidity decreased by nearly 40% after adjusting for age and functional liver status (OR: 0.61, 95%CI: 0.45-0.84, p=0.002). Conversely, there was no significant association between FLRV% and non-PHLF-related grade 4/5 morbidity (OR: 0.95, 95%CI: 0.74-1.21, p=0.65). FLRV% of ≥30% in NL and ≥50% in the IL group were established as safe minimum thresholds.
Conclusions: There was a close correlation between grade 4/5 PHLF-related morbidity and FLRV%, but the safe limit of resection was dependent on the liver remnant quality (>30% NL, >50% IL). By contrast, 50% of all grade 4/5 morbidity was unrelated to PHLF and not influenced by FLRV%.
Keywords: Future liver remnant volume; hepatectomy; liver failure.
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