Abstract
Background
This study examined whether the severity of posthepatectomy liver failure (PLF) affected the long-term postoperative liver recovery of patients with hepatocellular carcinoma (HCC).
Methods
We performed a retrospective cohort study of 395 HCC patients who underwent hepatectomy from 2004 to 2012 at the Kyoto University Hospital. The severity of PLF between postoperative days 5 and 10 was categorized according to the International Study Group of Liver Surgery criteria. We compared the Child-Pugh (C-P) score, platelet count (PLT), and the ratio of future remnant liver volume (FRLV) to the total liver volume (%RLV) at 3, 6, and 12 months after hepatectomy in the non-PLF, grade A, and grade B groups.
Results
The non-PLF, grade A, and grade B groups contained 272, 63, and 56 patients, respectively. The C-P score in the grade A group recovered from 5.37 points before hepatectomy to 5.38 points at 12 months after hepatectomy. The C-P score in the grade B group increased from 5.51 to 6.81 points at 3 months and was significantly higher (6.00 points) at 12 months than in the non-PLF group (5.47 points). The PLT significantly decreased at 12 months in the grade B group compared with the non-PLF group. The %RLV at 12 months in the non-PLF, grade A, and grade B groups were 84, 83, and 78 %, respectively. The remnant liver hypertrophy in the grade B group was significantly slower than that in the non-PLF group.
Conclusions
PLF severity affects long-term liver function recovery and remnant liver hypertrophy after hepatectomy.
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Supplemental Fig. 1
The subgroup analysis in terms of the degree of liver fibrosisa; A Child-Pugh (C-P) score and B platelet count (PLT). A In the F0-2 subgroup, the mean C-P scores at 3, 6, and 12 months in the non-PLF group were 5.31, 5.28, and 5.31 points, respectively; these scores were 5.47, 5.31, and 5.27 points, respectively, in the grade A group and 7.00, 6.40, and 5.70 points, respectively, in the grade B group. In the F3-4 subgroup, the mean C-P scores at 3, 6, and 12 months in the non-PLF group were 5.52, 5.59, and 5.60 points, respectively; these scores were 5.96, 5.83, and 5.46 points, respectively, in the grade A group and 6.64, 6.48, and 6.18 points, respectively, in the grade B group. B The mean values of PLT at 12 months in the non-PLF, grade A, and grade B groups were 151.3, 150.6, and 123.0 × 10³/μl for F0-2 and 116.3, 102.6, and 97.6 × 10³/μl for F3-4, respectively. PLF posthepatectomy liver failurea Liver fibrosis was classified as F0/1/2 or F3/4, according to the METAVIR scoring system [19]. * P value < 0.05, compared to the non-PLF group. Supplementary material 2 (TIFF 2128 kb)
Supplemental Fig. 2
The subgroup analysis of the changes in the remnant liver volume (RLV) in terms of the degree of liver fibrosisa. In the F0-2 subgroup, the mean %RLV values at 3, 6, and 12 months in the non-PLF group were 77.0, 80.4, and 83.2 %; these values were 73.5, 78.7, and 82.2 %, respectively, in the grade A group and 71.5, 80.0, and 82.9 %, respectively, in the grade B group. In the F3-4 subgroup, the mean %RLV values at 3, 6, and 12 months in the non-PLF group were 89.7, 82.2, and 84.1 %, respectively; these values were 74.4, 80.3, and 81.8 %, respectively, in the grade A group and 65.2, 73.7, and 75.3 %, respectively, in the grade B group. TLV total liver volume, FRLV future remnant liver volume, PLF posthepatectomy liver failure, RLV remnant liver volumea Liver fibrosis was classified as F0/1/2 or F3/4, according to the METAVIR scoring system [31]. * P value < 0.05, compared to the non-PLF group. Supplementary material 3 (TIFF 1311 kb)
Supplemental Fig. 3
The subgroup analysis in terms of the extent of liver resection (minor vs. majora); A Child-Pugh (C-P) score and B platelet count (PLT). A In the minor resection subgroup, the mean C-P scores at 3, 6, and 12 months in the non-PLF group were 5.44, 5.43, and 5.49 points, respectively; these values were 5.70, 5.62, and 5.43 points, respectively, in the grade A group and 6.18, 6.00, and 5.90 points, respectively, in the grade B group. In the major resection subgroup, the mean C-P scores at 3, 6, and 12 months in the non-PLF group were 5.39, 5.41, and 5.42 points, respectively; these values were 5.85, 5.62, and 5.25 points, respectively, in the grade A group and 7.37, 7.07, and 6.23 points, respectively, in the grade B group. B The mean values of PLT at 12 months in the non-PLF, grade A, and grade B groups were 130.6, 123.6, and 100.2 × 10³/μl for minor resections and 137.5, 109.3, and 114.4 × 10³/μl for major resections, respectively. PLF posthepatectomy liver failurea Major resection refers to resection of more than three segments defined according to Couinaud’s classification [30]. Minor resection refers to resection of fewer than three segments. * P value < 0.05, compared to the non-PLF group. Supplementary material 4 (TIFF 2118 kb)
Supplemental Fig. 4
Changes in the values of A Child-Pugh (C-P) score, B platelet count (PLT), and C remnant liver volume (RLV) after censoring the data of patients with postoperative recurrences. A The mean C-P scores at 3, 6, and 12 months in the non-PLF group were 5.39, 5.31, and 5.26 points, respectively; these scores were 5.65, 5.53, and 5.23 points, respectively, in the grade A group and 5.82, 6.16, and 5.81 points, respectively, in the grade B group. B The mean values of PLT at 12 months in the non-PLF, grade A, and grade B groups were 137.2, 111.8, and 106.2 × 10³/μl, respectively. C The mean %RLV values at 3, 6, and 12 months in the non-PLF group were 78.2, 81.1, and 85.6 %; these values were 74.1, 80.7, and 82.6 %, respectively, in the grade A group and 67.0, 74.8, and 71.0 %, respectively, in the grade B group. TLV total liver volume, FRLV future remnant liver volume, PLF posthepatectomy liver failure, RLV remnant liver volume. * P value < 0.05, compared to the non-PLF group. Supplementary material 5 (TIFF 2447 kb)
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Nakamura, N., Hatano, E., Iguchi, K. et al. Posthepatectomy Liver Failure Affects Long-Term Function After Resection for Hepatocellular Carcinoma. World J Surg 40, 929–936 (2016). https://doi.org/10.1007/s00268-015-3345-5
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DOI: https://doi.org/10.1007/s00268-015-3345-5