Minimum proportion of future liver remnant in safe major hepatopancreatoduodenectomy
Abstract Background and Aim Post‐hepatectomy liver failure (PHLF) after major hepatopancreatoduodenectomy (HPD) is a challenge to overcome. However, the appropriate target proportion of the future liver remnant (pFLR) to prevent severe PHLF in major HPD remains uncertain. This study aimed to determi...
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| Format: | Article |
| Language: | English |
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Wiley
2025-01-01
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| Series: | Annals of Gastroenterological Surgery |
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| Online Access: | https://doi.org/10.1002/ags3.12850 |
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| author | Kentaro Umemura Akira Shimizu Tsuyoshi Notake Koji Kubota Kiyotaka Hosoda Koya Yasukawa Atsushi Kamachi Takamune Goto Hidenori Tomida Yuji Soejima |
| author_facet | Kentaro Umemura Akira Shimizu Tsuyoshi Notake Koji Kubota Kiyotaka Hosoda Koya Yasukawa Atsushi Kamachi Takamune Goto Hidenori Tomida Yuji Soejima |
| author_sort | Kentaro Umemura |
| collection | DOAJ |
| description | Abstract Background and Aim Post‐hepatectomy liver failure (PHLF) after major hepatopancreatoduodenectomy (HPD) is a challenge to overcome. However, the appropriate target proportion of the future liver remnant (pFLR) to prevent severe PHLF in major HPD remains uncertain. This study aimed to determine the minimum pFLR required for safe major HPD. Methods This retrospective study involved 48 major HPD patients. We assessed pFLR and remnant liver function scores (pFLR × albumin‐bilirubin [ALBI] / albumin‐indocyanine green evaluation [ALICE]/plasma clearance rate of indocyanine green [KICG]) as predictors for Grade B/C PHLF and established safety criteria. Results Grade B/C PHLF occurred in 40% of the patients (n = 19), leading to severe morbidity and two in‐hospital deaths. pFLR was a good predictor of Grade B/C PHLF [area under the curve (AUC) 0.80, p < 0.01] with a 45% optimal cutoff. While all remnant liver function scores predicted PHLF, the remnant ALICE demonstrated the best predictability (AUC 0.85, p < 0.01), with the sensitivity and specificity at 89% and 83%, respectively, using −0.86 as the cutoff. Independent risk factors for Grade B/C PHLF were remnant ALICE ≥−0.86 and blood loss ≥1500 mL. Grade B/C PHLF developed in 14% with pFLR ≥45% but reached 64% with pFLR <45%. However, the rate could be reduced to 33% with remnant ALICE <−0.86. Conclusion To prevent Grade B/C PHLF, a pFLR ≥45% is recommended. Nevertheless, major HPD may be considered in patients with good remnant liver function. |
| format | Article |
| id | doaj-art-5e7227efb48e4ab8a98210a9e7586be9 |
| institution | Kabale University |
| issn | 2475-0328 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Annals of Gastroenterological Surgery |
| spelling | doaj-art-5e7227efb48e4ab8a98210a9e7586be92025-01-02T04:49:00ZengWileyAnnals of Gastroenterological Surgery2475-03282025-01-019118819810.1002/ags3.12850Minimum proportion of future liver remnant in safe major hepatopancreatoduodenectomyKentaro Umemura0Akira Shimizu1Tsuyoshi Notake2Koji Kubota3Kiyotaka Hosoda4Koya Yasukawa5Atsushi Kamachi6Takamune Goto7Hidenori Tomida8Yuji Soejima9Division of Gastroenterological, Hepato‐Biliary‐Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery Shinshu University School of Medicine Matsumoto JapanDivision of Gastroenterological, Hepato‐Biliary‐Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery Shinshu University School of Medicine Matsumoto JapanDivision of Gastroenterological, Hepato‐Biliary‐Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery Shinshu University School of Medicine Matsumoto JapanDivision of Gastroenterological, Hepato‐Biliary‐Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery Shinshu University School of Medicine Matsumoto JapanDivision of Gastroenterological, Hepato‐Biliary‐Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery Shinshu University School of Medicine Matsumoto JapanDivision of Gastroenterological, Hepato‐Biliary‐Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery Shinshu University School of Medicine Matsumoto JapanDivision of Gastroenterological, Hepato‐Biliary‐Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery Shinshu University School of Medicine Matsumoto JapanDivision of Gastroenterological, Hepato‐Biliary‐Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery Shinshu University School of Medicine Matsumoto JapanDivision of Gastroenterological, Hepato‐Biliary‐Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery Shinshu University School of Medicine Matsumoto JapanDivision of Gastroenterological, Hepato‐Biliary‐Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery Shinshu University School of Medicine Matsumoto JapanAbstract Background and Aim Post‐hepatectomy liver failure (PHLF) after major hepatopancreatoduodenectomy (HPD) is a challenge to overcome. However, the appropriate target proportion of the future liver remnant (pFLR) to prevent severe PHLF in major HPD remains uncertain. This study aimed to determine the minimum pFLR required for safe major HPD. Methods This retrospective study involved 48 major HPD patients. We assessed pFLR and remnant liver function scores (pFLR × albumin‐bilirubin [ALBI] / albumin‐indocyanine green evaluation [ALICE]/plasma clearance rate of indocyanine green [KICG]) as predictors for Grade B/C PHLF and established safety criteria. Results Grade B/C PHLF occurred in 40% of the patients (n = 19), leading to severe morbidity and two in‐hospital deaths. pFLR was a good predictor of Grade B/C PHLF [area under the curve (AUC) 0.80, p < 0.01] with a 45% optimal cutoff. While all remnant liver function scores predicted PHLF, the remnant ALICE demonstrated the best predictability (AUC 0.85, p < 0.01), with the sensitivity and specificity at 89% and 83%, respectively, using −0.86 as the cutoff. Independent risk factors for Grade B/C PHLF were remnant ALICE ≥−0.86 and blood loss ≥1500 mL. Grade B/C PHLF developed in 14% with pFLR ≥45% but reached 64% with pFLR <45%. However, the rate could be reduced to 33% with remnant ALICE <−0.86. Conclusion To prevent Grade B/C PHLF, a pFLR ≥45% is recommended. Nevertheless, major HPD may be considered in patients with good remnant liver function.https://doi.org/10.1002/ags3.12850albumin‐indocyanine green evaluationbiliary cancerhepatopancreatoduodenectomyliver failureliver volume |
| spellingShingle | Kentaro Umemura Akira Shimizu Tsuyoshi Notake Koji Kubota Kiyotaka Hosoda Koya Yasukawa Atsushi Kamachi Takamune Goto Hidenori Tomida Yuji Soejima Minimum proportion of future liver remnant in safe major hepatopancreatoduodenectomy Annals of Gastroenterological Surgery albumin‐indocyanine green evaluation biliary cancer hepatopancreatoduodenectomy liver failure liver volume |
| title | Minimum proportion of future liver remnant in safe major hepatopancreatoduodenectomy |
| title_full | Minimum proportion of future liver remnant in safe major hepatopancreatoduodenectomy |
| title_fullStr | Minimum proportion of future liver remnant in safe major hepatopancreatoduodenectomy |
| title_full_unstemmed | Minimum proportion of future liver remnant in safe major hepatopancreatoduodenectomy |
| title_short | Minimum proportion of future liver remnant in safe major hepatopancreatoduodenectomy |
| title_sort | minimum proportion of future liver remnant in safe major hepatopancreatoduodenectomy |
| topic | albumin‐indocyanine green evaluation biliary cancer hepatopancreatoduodenectomy liver failure liver volume |
| url | https://doi.org/10.1002/ags3.12850 |
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