Postoperative liver failure after major hepatic resection for hepatocellular carcinoma in the modern era with special reference to remnant liver volume

1999 ◽  
Vol 188 (3) ◽  
pp. 304-309 ◽  
Author(s):  
Ken Shirabe ◽  
Mitsuo Shimada ◽  
Tomonobu Gion ◽  
Hirofumi Hasegawa ◽  
Kenji Takenaka ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Failure ◽  
Hepatic Resection ◽  
Special Reference ◽  
Liver Volume ◽  
Postoperative Liver Failure ◽  
Remnant Liver ◽  
Major Hepatic Resection ◽  
Remnant Liver Volume ◽  
Modern Era

scholarly journals Morbidity and Mortality After Major Hepatic Resection in Cirrhotic Patients with Hepatocellular Carcinoma

HPB Surgery ◽  
1988 ◽  
Vol 1 (1) ◽  
pp. 45-56 ◽  
Author(s):  
Naofumi Nagasue ◽  
Hirofumi Yukaya ◽  
Hitoshi Kohno ◽  
Yu-Chung Chang ◽  
Teruhisa Nakamura
Keyword(s):  
Hepatocellular Carcinoma ◽  
Postoperative Complications ◽  
Liver Failure ◽  
Hepatic Resection ◽  
Survival Rates ◽  
Postoperative Liver Failure ◽  
Major Hepatic Resection ◽  
Class B ◽  
Left Lobectomy ◽  
Left Lateral Segmentectomy

Major hepatic resection was carried out on 23 adult patients with hepatocellular carcinoma (HCC) and underlying cirrhosis of the liver (macronodular in six cases, micronodular in 11, and mixed type cirrhosis in six). Pre-operative liver functional state was Child's class A in 19, class B in three, and class C in one. The operations performed were extended right lobectomy in four patients, right lobectomy in 10, left lobectomy in one, and left lateral segmentectomy in eight. Fifteen postoperative complications were found in 10 patients, five of whom had duplicated complications and finally died of liver failure 15–65 days after operation. In three of those five patients, other complications (hemorrhagic shock in two and portal thrombosis in one) had preceded liver failure. Eighteen patients tolerated the resection and were discharged from hospital. However, among 13 noncirrhotic patients with HCC who had undergone major hepatic resection during the same period of time, only two had postoperative complications and all patients were discharged from hospital. The 1-, 2- and 3-year survival rates in the 23 cirrhotics were 60.9%, 37.5% and 24.9% respectively, whereas the 1–5-year survival rates were all 61.5% in the 13 noncirrhotics. Thus, major hepatic resection may be indicated in selected patients with HCC and associated cirrhosis, but meticulous managements during and after operation are mandatory to prevent fatal postoperative liver failure.

Relationship between platelet count and hepatic failure and residual liver regeneration after hemihepatectomy in patients with hepatitis B-related primary hepatocellular carcinoma

2019 ◽  
Author(s):  
Chuhui Ye ◽  
Banghao Xu ◽  
Kaiyi Lu ◽  
Tingting Lu ◽  
Ling Zhang ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Resection ◽  
Hepatitis B ◽  
Liver Failure ◽  
Liver Regeneration ◽  
Liver Volume ◽  
Primary Hepatocellular Carcinoma ◽  
Postoperative Liver Failure ◽  
Regeneration Rate ◽  
Significant Difference

Abstract Objective A retrospective analysis of the influences of platelet (PLT) counts on liver failure and liver regeneration in patients with primary hepatocellular carcinoma (HCC) provides a treatment strategy for clinical prevention and treatment of postoperative liver failure and residual liver regeneration. Method The clinical data of 111 patients with a background of hepatitis B virus infection and who underwent (expanded) half liver resection at the First Affiliated Hospital of Guangxi Medical University from June 2012 to June 2017 were collected and statistically analyzed. Results　On the basis of the International Study Group of Liver Surgery liver failure-grading standards and Dino–Clavien postoperative complication criteria, the incidence of grade B and above liver failure was 55%, and complication II level and above was 47.5% in the PLT decline group after semihepatectomy. The incidence rates in the normal group were 26.8% and 23.9%. A statistically significant difference was determined in the two groups (P1=0.003, P2 = 0.011). The average volumes of liver hyperplasia (residual liver volume (RLV)80.4 days − RLV) in the PLT decline and normal groups were 132.09 ± 61.89 cm3 and 190.89 ± 91.98c cm3, respectively; the average rates of hyperplasia ((RLV80.4days−RLV)/RLV) were 16.59%± 7.36% and 24.78% ± 10.82%. The difference between the two groups was statistically significant (PProliferation = 0.001, PProliferation rate = 0.001). Univariable and multivariable logistic regression analyses of postoperative liver failure grade and proliferation rate in patients who underwent semihepatectomy suggested that the decrease in postoperative PLT count (PLT < 125 × 109/L) might be an independent risk factor of severe posthepatectomy liver failure (PHLF) (PHLF-B or above) and residual liver regeneration rate for patients with primary HCC after half liver resection. No death occurred. Conclusions A correlation existed between PLT count and postoperative PHLF or liver regeneration. Monitoring PLT counts after liver resection may help us predict the suffering from PHLF-B or above and severe postoperative complications.

scholarly journals Utility of remnant liver volume for predicting posthepatectomy liver failure after hepatectomy with extrahepatic bile duct resection

BJS Open ◽  
2021 ◽  
Vol 5 (1) ◽  
Author(s):  
R Yamamoto ◽  
T Sugiura ◽  
Y Okamura ◽  
T Ito ◽  
Y Yamamoto ◽  
...  
Keyword(s):  
Risk Factors ◽  
Bile Duct ◽  
Liver Failure ◽  
Extrahepatic Bile Duct ◽  
Liver Volume ◽  
Remnant Liver ◽  
Bile Duct Resection ◽  
Posthepatectomy Liver Failure ◽  
Remnant Liver Volume ◽  
Extrahepatic Bile Duct Resection

Abstract Background Hepatectomy with extrahepatic bile duct resection is associated with a high risk of posthepatectomy liver failure (PHLF). However, the utility of the remnant liver volume (RLV) in cholangiocarcinoma has not been studied intensively. Methods Patients who underwent major hepatectomy with extrahepatic bile duct resection between 2002 and 2018 were reviewed. The RLV was divided by body surface area (BSA) to normalize individual physical differences. Risk factors for clinically relevant PHLF were evaluated with special reference to the RLV/BSA. Results A total of 289 patients were included. The optimal cut-off value for RLV/BSA was determined to be 300 ml/m2. Thirty-two patients (11.1 per cent) developed PHLF. PHLF was more frequent in patients with an RLV/BSA below 300 ml/m2 than in those with a value of 300 ml/m2 or greater: 19 of 87 (22 per cent) versus 13 of 202 (6.4 per cent) (P &lt; 0.001). In multivariable analysis, RLV/BSA below 300 ml/m2 (P = 0.013), future liver remnant plasma clearance rate of indocyanine green less than 0.075 (P = 0.031), and serum albumin level below 3.5 g/dl (P = 0.015) were identified as independent risk factors for PHLF. Based on these risk factors, patients were classified into three subgroups with low (no factors), moderate (1–2 factors), and high (3 factors) risk of PHLF, with PHLF rates of 1.8, 14.8 and 63 per cent respectively (P &lt; 0.001). Conclusion An RLV/BSA of 300 ml/m2 is a simple predictor of PHLF in patients undergoing hepatectomy with extrahepatic bile duct resection.

Conversion hepatectomy for hepatocellular carcinoma with inadequate future- remnant- liver after portal vein ligation in combination with apatinib plus camrelizimab: A single-arm prospective pilot study (PLACES).

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e16132-e16132
Author(s):  
Zhiming Zeng ◽  
Guangzhi Zhu ◽  
Huasheng Huang ◽  
Yangfeng Jiang ◽  
Xinping Ye ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Portal Vein ◽  
Hepatic Resection ◽  
Retention Rate ◽  
Objective Response ◽  
Liver Volume ◽  
Portal Vein Ligation ◽  
Remnant Liver ◽  
Future Remnant Liver ◽  
Second Stage

e16132 Background: A variety of staged hepatic resection has been applied in patients (pts) with hepatocellular carcinoma (HCC) who had an inadequate future-remnant-liver (FRL), but the clinical outcomes remain unsatisfactory. Based on the clinical data of apatinib (a highly selective VEGFR-2 inhibitor) and camrelizimab (anti‐PD‐1 antibody) in HCC pts, we therefore evaluated the safety and efficacy of portal vein ligation (PVL) in combination with apatinib plus camrelizimab for primary HCC with insufficient residual liver volume. Methods: Pts aged 18-75, with HCC, Child-Pugh A status, BCLC stage A-C, preoperative indocyanine green retention rate at 15 min < 10%, and preoperative FLR/standardized liver volume (SLV) < 30% (for pts without cirrhosis ) and < 40% (for pts with cirrhosis ) were enrolled. Pts received PVL followed by camrelizimab (200mg, iv, d1 q2w) plus apatinib (250mg, po, pd, q2w) until surgical criteria were met. Pts underwent second-stage hepatic resection 4 weeks after treatment discontinuation, and continued treatment with apatinib plus camrelizimab for 1 year or endpoints occurred. The primary endpoints were resection rate of conversion surgery and ORR (objective response rate). Results: Between Apr 21, 2020 to Jan 20, 2021, 14 pts were enrolled in this trial. The estimated median preoperative FLR/SLV for all pts was 34.6%. Among the 10 evaluable pts, 7 met the criteria for surgery and 5 completed second-stage hepatectomy except for 2 pt who refused and waited for surgery, respectively. The median interval time of the two stages of surgery was 138.8 days. ORR was 40%, and disease control rate (DCR) was 100% (4 pts with partial response and 6 pts with stable disease). The other 4 pts are waiting for the evaluation. No adverse events (AEs) of grade 3 or worse occurred after PVL. The most common treatment-related AEs in pts during treatment with apatinib plus camrelizimab included hypoalbuminemia (36%), increased aspartate aminotransferase (AST) (100%) and rash (29%). Major AEs in pts underoing second-stage hepatectomy were pneumonia (100%), increased AST (100%), increased alanine transaminase (100%) and anemia (100%). One patient died of postoperative pulmonary infection. Conclusions: PVL in combination with apatinib plus camrelizimab followed by staged resection may be a safe and effective treatment option for HCC pts with insufficient FLR. Clinical trial information: ChiCTR2000033692.

Liver regeneration after hemihepatectomy in patients with hepatocellular carcinoma.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 339-339
Author(s):  
Wen-Feng Gong ◽  
Jian-Hong Zhong ◽  
Liang Ma ◽  
Bang-De Xiang ◽  
Le-Qun Li
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Cirrhosis ◽  
Liver Function ◽  
Liver Failure ◽  
Liver Regeneration ◽  
Liver Volume ◽  
Remnant Liver ◽  
Clinical Factors ◽  
Liver Remnant ◽  
Factors Associated

339 Background: We explored clinical factors associated with extent of liver regeneration after hemihepatectomy to treat hepatocellular carcinoma (HCC), as well as how the extent of regeneration influences postoperative recovery of liver function. Methods: In this prospective study of 125 patients who underwent hemihepatectomy, future liver remnant volume (as a percentage of functional liver volume, %FLRV) and remnant liver volume were measured preoperatively and at 1, 5, 9 and 13 weeks postoperatively. Logistic regression was used to identify clinical factors associated with liver regeneration. Influence of liver regeneration on postoperative liver function was evaluated. Results: After hepatectomy, 1 of 125 patients (0.8%) died within 3 months, 13 (10.4%) experienced liver failure and 99 (79.2%) experienced complications. %FLRV was able to predict liver failure with an area under the receiver operating characteristic curve of 0.900, and a cut-off value of 42.7% showed sensitivity of 85.7% and specificity of 88.6%. Postoperative median growth ratio was 21.3% at 1 week, 30.9% at 5 weeks, 34.6% at 9 weeks and 37.1% at 13 weeks. Multivariate analysis identified three predictors associated with liver regeneration: FLRV < 601 cm3 (OR 0.230, 95%CI 0.074-0.717), %FLRV (OR 0.271, 95%CI 0.077-0.960) and liver cirrhosis (OR 7.740, 95%CI 2.748-21.798). At postoperative weeks 1 and 5, liver function indicators were significantly better among patients showing high extent of regeneration than among those showing low extent, but these differences disappeared by postoperative week 9. Conclusions: FLRV, %FLRV and liver cirrhosis strongly influence extent of liver regeneration after hepatectomy. %FLRV values below 42.7% are associated with greater risk of post-hepatectomy liver failure.

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