Clinically Related Factors of Liver Failure in Patients With Liver Cirrhosis After Hepatectomy

Many patients with cirrhosis develop posthepatectomy liver failure (PHLF). Factors associated with clinically relevant PHLF (CRPHLF) in cirrhosis with different remnant liver volume (RLV)-to-standard liver volume (SLV) ratios are unclear.

The study aimed to determine whether an RLV/SLV value of <40% is safe for hepatectomy in patients with cirrhosis.

Patients with cirrhosis were divided into an RLV/SLV <40% group (28 cases) and an RLV/SLV ≥40% group (39 cases) based on their RLV/SLV ratio. The incidence of CRPHLF and surgical complications in the 2 groups were analysed, and CRPHLF was determined according to the criteria of the International Study Group of Liver Surgery. Factors associated with CRPHLF were identified using multivariate logistic regression for all patients. We further performed the Hosmer-Lemeshow test and calculated the area under the receiver operating characteristic curve (AUC) to assess the overall model fit. All analyses were performed using SPSS 19.0 software.

Patients who developed CRPHLF had a higher rate of severe complications (17.1%) than those who did not. Body mass index (BMI), prothrombin time (PT), RLV/SLV value, and blood transfusion were associated with CRPHLF in all patients with cirrhosis ( P <0.05). Clinically relevant PHLF was associated with PT in patients with RLV/SLV ≥40% and with BMI in patients with RLV/SLV <40% ( P <0.05). Model diagnostics suggested satisfactory calibration (Hosmer-Lemeshow P =0.436) and moderate discrimination (AUC=0.78) in the overall cohort. Patients with cirrhosis with an RLV/SLV value of <40% (and ≥30%) had the same complications or CRPHLF as patients with an RLV/SLV value of ≥40% ( P >0.05).

We found that a high PT was a risk factor in patients with RLV/SLV ≥40%, while a low BMI was a risk factor in those with RLV/SLV <40%. Increased surgical complications may not be associated with low RLV/SLV ratios, and hepatectomy may be safe in some patients with cirrhosis with RLV/SLV values <40% (and ≥30%).