Skip to main content
Log in

Posthepatectomy Liver Failure Affects Long-Term Function After Resection for Hepatocellular Carcinoma

  • Original Scientific Report
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Jemal A, Bray F, Center MM et al (2011) Global cancer statics. CA Cancer J Clin 61:69–90

    Article  PubMed  Google Scholar 

  2. Forner A, Llovet JM, Bruix J (2012) Hepatocellular carcinoma. Lancet 379:1245–1255

    Article  PubMed  Google Scholar 

  3. De Lope CR, Tremosini S, Forner A et al (2012) Management of HCC. J hepatol 56:S75–S87

    Article  PubMed  Google Scholar 

  4. Chok KS, Ng KK, Poon RT et al (2009) Impact of postoperative complications on long-term outcome of curative resection for hepatocellular carcinoma. Br J Surg 96:81–87

    Article  CAS  PubMed  Google Scholar 

  5. Kawano Y, Sasaki A, Kai S et al (2008) Short and long-term outcome after hepatic resection for hepatocellular carcinoma with concomitant esophageal varices in patients with cirrhosis. Ann Surg Oncol 15:1670–1676

    Article  PubMed  Google Scholar 

  6. Okumura Y, Takeda S, Fujii T et al (2011) Prognostic significance of postoperative complications after hepatectomy for hepatocellular carcinoma. J Surg Oncol 104:814–821

    Article  Google Scholar 

  7. Yang T, Zhang J, Lu JH et al (2011) Risk factors influencing postoperative outcomes of major hepatic resection of hepatocellular carcinoma for patients with underlying liver diseases. World J Surg 35:2073–2082. doi:10.1007/s00268-011-1161-0

    Article  PubMed  Google Scholar 

  8. Poon RT, Fan ST, Lo CM et al (2001) Improving survival results after resection of hepatocellular carcinoma: a prospective study of 377 patients over 10 years. Ann Surg 234:63–70

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  9. Cescon M, Vetrone G, Grazi GL et al (2009) Trends in perioperative outcome after hepatic resection: analysis of 1500 consecutive unselected cases over 20 years. Ann Surg 249:995–1002

    Article  PubMed  Google Scholar 

  10. Fukushima K, Fukumoto T, Kuramitsu K et al (2014) Assessment of ISGLS definition of posthepatectomy liver failure and its effect on outcome in patients with hepatocellular carcinoma. J Gastrointest Surg 18:729–736

    Article  PubMed  Google Scholar 

  11. Van den Broek MA, Olde Damink SW, Dejong CH et al (2008) Liver failure after partial hepatic resection: definition, pathophysiology, risk factors and treatment. Liver Int 28:767–780

    Article  PubMed  Google Scholar 

  12. Hammond JS, Guha IN, Beckingham IJ et al (2011) Prediction, prevention and management of postoperative liver failure. Br J Surg 98:1188–1200

    Article  CAS  PubMed  Google Scholar 

  13. Kim SH, Kang DR, Lee JG et al (2013) Early predictor of mortality due to irreversible posthepatectomy liver failure in patients with hepatocellular carcinoma. World J Surg 37:1028–1033. doi:10.1007/s00268-013-1959-z

    Article  PubMed  Google Scholar 

  14. Rahbari NN, Garden OJ, Padbury R et al (2011) Posthepatectomy liver failure: a definition and dragging by the International Study Group of Liver Surgery (ISGLS). Surgery 149:713–724

    Article  PubMed  Google Scholar 

  15. Rahbari NN, Reissfelder C, Koch M et al (2011) The predictive value of postoperative clinical risk scores for outcome after hepatic resection: a validation analysis in 807 patients. Ann Surg Oncol 18:3640–3649

    Article  PubMed  Google Scholar 

  16. Iguchi K, Hatano E, Yamanaka K et al (2014) The impact of posthepatectomy liver failure on the recurrence of hepatocellular carcinoma. World J Surg 38:150–158. doi:10.1007/s00268-013-2247-7

    Article  PubMed  Google Scholar 

  17. Llovet JM, Bruix J (2008) Novel advancements in the management of hepatocellular carcinoma in 2008. J Hepatol 48:S20–S37

    Article  CAS  PubMed  Google Scholar 

  18. Naito S, Imamura H, Tukada A et al (2014) Postoperative recurrence pattern and prognosis of patients with hepatocellular carcinoma, with particular reference to the hepatitis viral infection status. Liver Int 34:802–813

    Article  PubMed  Google Scholar 

  19. Iguchi K, Hatano E, Yamanaka K et al (2015) Validation of the conventional resection criteria in patients with hepatocellular carcinoma in terms of the incidence of posthepatectomy liver failure and long-term prognosis. Dig Surg 32:344–351

    Article  PubMed  Google Scholar 

  20. Lin T-Y, Chen CC (1965) Metabolic function and regeneration of cirrhotic and non-cirrhotic livers after hepatic lobectomy in man. Ann Surg 162:959–972

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  21. Nagasue N, Yukaya H, Ogawa Y et al (1987) Human liver regeneration after major hepatic resection. Ann Surg 206:30–39

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  22. Yamanaka N, Okamoto E, Kawamura E et al (1993) Dynamics of normal and injured human liver regeneration after hepatectomy as assessed on the basis of computed tomography and liver function. Hepatology 18:79–85

    Article  CAS  PubMed  Google Scholar 

  23. Nadalin S, Testa G, Malago M et al (2004) Volumetric and functional recovery of the liver after right hepatectomy for living donation. Liver Transplant 10:1024–1029

    Article  Google Scholar 

  24. Manny DV, Lam WW, Hjelm NM et al (2001) Human liver regeneration: hepatic energy economy is less efficient when the organ is diseased. Hepatology 34:557–565

    Article  Google Scholar 

  25. Kele PG, De Boer M, van der Jagt EJ et al (2012) Early hepatic regeneration index and completeness of regeneration at 6 month after partial hepatectomy. Br J Surg 99:1113–1119

    Article  CAS  PubMed  Google Scholar 

  26. Truant S, Bouras AF, Petrovai G et al (2013) Volumetric gain of the liver after major hepatectomy in obese patents. Ann Surg 258:696–704

    Article  PubMed  Google Scholar 

  27. Kwon AH, Matsui Y, Ha-Kawa SK et al (2001) Functional hepatic volume measured by technetium-99m-galactosyl-human serum albumin liver scintigraphy: comparison between hepatocyte volume and liver volume by computed tomography. AJG 96:541–546

    Article  CAS  PubMed  Google Scholar 

  28. Clavien P, Pertowsky H, DeOliveira ML et al (2007) Medical progress: strategies for safer liver surgery and partial liver transplantation. N Engl J 356:1545–1559

    Article  Google Scholar 

  29. Chen MF, Hwang TL, Hung CF (1991) Human liver regeneration after major hepatectomy. Ann Surg 213:227–291

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  30. Couinaud C (1954) Lobes et segments hepatiques-notes sur larchitecture anatomique et chirurgicale du foie. Presse Med 62:709–712

    CAS  PubMed  Google Scholar 

  31. Bedossa P, Poynard T (1996) An algorithm for the grading of activity in chronic hepatitis C. The METAVIR Cooperative Study Group. Hepatology 24:289–293

    Article  CAS  PubMed  Google Scholar 

  32. Liver Cancer Study Group of Japan (2009) The general rules for the clinical and pathological study of primary liver cancer. Kanehara, Tokyo

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Etsuro Hatano.

Ethics declarations

Conflict of interest

The authors declare no conflict of interest in connection with this study.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 23 kb)

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)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-015-3345-5

Keywords

Navigation