Preoperative Systemic Pan-Immune-Inflammation Value Predicts Posthepatectomy Liver Failure After Laparoscopic
Xiuyu Wu1,2, Shun Xu1, Tianqi Zhang3
1Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China.
Background:
Post-hepatectomy liver failure (PHLF) remains a major cause of morbidity after liver resection for hepatocellular carcinoma (HCC). Routine blood-count-based inflammatory indices may complement established liver reserve assessments. This study evaluated whether preoperative systemic pan-immune-inflammation value (S-PIV) predicts PHLF after conventional laparoscopic hepatectomy for HCC.
Methods:
We conducted a single-center retrospective cohort study of consecutive patients who completed conventional laparoscopic hepatectomy for liver tumors between January 2017 and December 2025. Eligible patients had pathologically confirmed HCC and complete preoperative laboratory data within 7 days before surgery. Planned open hepatectomy, conversion to open surgery, and robotic-assisted hepatectomy were outside the predefined cohort scope. S-PIV was calculated as neutrophil count × monocyte count × platelet count / lymphocyte count. The primary outcome was ISGLS-defined PHLF, analyzed as any-grade PHLF versus no PHLF. Discrimination was assessed using ROC analysis, dose-response using restricted cubic splines, and clinical utility using decision curve analysis.
Results:
Among 582 screened patients, 356 were included; 68 (19.1%) developed PHLF. Preoperative S-PIV showed good discrimination for PHLF (AUC 0.873). The Youden index identified an optimal cut-off of 455.4, with sensitivity 0.726 and specificity 0.908. S-PIV showed higher AUCs than NLR (0.831) and PLR (0.848). Higher S-PIV was associated with PHLF in univariable analysis (per 100 units: OR 1.12, 95% CI 1.06-1.45; P<0.001) and remained independently associated after sequential adjustment for demographics/comorbidities, liver functional reserve, and tumor/operative factors (Model 3 per 100 units: OR 1.06, 95% CI 1.03-1.13; P<0.001). Restricted cubic splines showed a graded risk increase without evidence of nonlinearity, and decision curve analysis suggested net benefit across threshold probabilities of approximately 10%-70%.
Conclusion:
Preoperative S-PIV, derived from routine blood counts, may serve as a practical adjunct for PHLF risk stratification after conventional laparoscopic hepatectomy for HCC. External multicenter validation and calibration are urgently required before routine implementation.
