Impact of the fibrosis-4 index on postoperative complications in patients undergoing laparoscopic liver resection

The objective of this study was to evaluate the relationship between preoperative fibrosis-4 (FIB-4) index and postoperative complications in the patients undergoing laparoscopic liver resection (LLR) for liver tumors.

The 196 patients undergoing LLR were retrospectively analyzed. The patients with the FIB-4 index over 2.67 were classified as the high FIB-4 group. Clinicopathological characteristics and the incidence of postoperative major complications were compared between the high FIB-4 and standard groups. Inverse probability of treatment weighting (IPTW) analysis using propensity scores was performed to minimize selection bias in comparisons between the two groups.

Among the 196 patients, 92 (47%) were classified into the high FIB-4 group, and the remaining 104 (53%) were classified into the standard FIB-4 group. Postoperative major complications developed in 20 patients (10%). Multiple indicators of liver function and liver fibrosis were significantly worse in the high FIB-4 group. Blood loss per unit liver transection area and operation time per unit liver transection area were significantly greater in the high FIB-4 group (p = 0.009 and p = 0.004, respectively). The incidence of major postoperative complications was significantly higher in the high FIB-4 group (p = 0.009). These differences remained significant after IPTW adjustment.

A high FIB-4 index was significantly associated with increased intraoperative blood loss and a higher incidence of postoperative complications following LLR.