肝肥大化手技後の大肝切除術における無益性の予測因子：二施設共同コホート研究

hypertrophy techniques expanded surgical indications, but some patients still experience limited clinical benefit. We aimed to identify futility predictive factors in major hepatectomies after liver venous deprivation (LVD) or ALPPS-variants (tourniquet-ALPPS or hybrid-ALPPS).

a bi-institutional cohort study conducted between 01/2015 and 07/2024 including major hepatectomies for oncologic disease following one of the three augmentation strategies.

age <18, benign pathology, follow-up < 6-months, and interstage dropout. Futility corresponded to 90-days mortality or very early recurrence (≤6 months). Predictors of futile outcomes were identified by uni- and multi-variate analyses and utilized to build a futility score (0-10).

84 patients completed the surgical process (dropout rate: 21.1 %): 40.5 % underwent LVD, 33.3 % tourniquet-ALPPS, and 26.2 % hybrid-ALPPS. Futility was observed in 35 patients (41.7 %) and logistic regression identified baseline sFLR (OR 0.89, p = 0.013), associated procedures (OR 3.07, p = 0.046), right trisectionectomy (OR 5.61, p = 0.031), and non-radical resection (OR 4.31, p = 0.01) as independent predictors. A futility score ≥4 (n = 36) predicted a futile outcome with good discrimination (AUC 0.802; p < 0.001).

Technical success after hypertrophy techniques not always equates clinical benefit. Recognizing predictors of futility may improve patient selection and guide more personalized therapeutic strategies.