Is conventional functional liver remnant volume higher than 40% still sufficient to prevent post-hepatectomy liver failure in jaundiced patients with hilar cholangiocarcinoma? A single-center experience in China.

Publisher: John Wiley & Sons Ltd Country of Publication: United States NLM ID: 101595310 Publication Model: Print Cited Medium: Internet ISSN: 2045-7634 (Electronic) Linking ISSN: 20457634 NLM ISO Abbreviation: Cancer Med Subsets: MEDLINE

Original Publication: [Malden, MA] : John Wiley & Sons Ltd., c2012-

Hepatectomy*/adverse effects ; Klatskin Tumor*/surgery ; Klatskin Tumor*/pathology ; Bile Duct Neoplasms*/surgery ; Bile Duct Neoplasms*/pathology ; Liver Failure*/etiology ; Liver Failure*/prevention & control ; Jaundice*/etiology; Humans ; Male ; Female ; Middle Aged ; Retrospective Studies ; China/epidemiology ; Liver/surgery ; Liver/pathology ; Aged ; Postoperative Complications/etiology ; Postoperative Complications/prevention & control ; Postoperative Complications/epidemiology ; Prognosis ; Adult ; Organ Size

Objective: Our study aims to evaluate the predictive accuracy of functional liver remnant volume (FLRV) in post-hepatectomy liver failure (PHLF) among surgically-treated jaundiced patients with hilar cholangiocarcinoma (HCCA).
Methods: We retrospectively reviewed surgically-treated jaundiced patients with HCCA between June, 2000 and June, 2018. The correlation between FRLV and PHLF were analyzed. The optimal cut off value of FLRV in jaundiced HCCA patients was also identified and its impact was furtherly evaluated.
Results: A total of 224 jaundiced HCCA patients who received a standard curative resection (43 patients developed PHLF) were identified. Patients with PHLF shared more aggressive clinic-pathological features and were generally in a more advanced stage than those without PHLF. An obvious inconsistent distribution of FLRV in patients with PHLF and those without PHLF were detected. FLRV (continuous data) had a high predictive accuracy in PHLF. The newly-acquired cut off value (FLRV = 53.5%, sensitivity = 81.22%, specificity = 81.4%) showed a significantly higher predictive accuracy than conventional FLRV cut off value (AUC: 0.81 vs. 0.60, p < 0.05). Moreover, patients with FLRV lower than 53.5% also shared a significantly higher major morbidity rate as well as a worse prognosis, which were not detected for FLRV of 40%.
Conclusion: For jaundiced patients with HCCA, a modified FLRV of 53.5% is recommended due to its great impact on PHLF, as well as its correlation with postoperative major morbidities as well as overall prognosis, which might help clinicians to stratify patients with different therapeutic regimes and outcomes. Future multi-center studies for training and validation are required for further validation.
(© 2024 The Author(s). Cancer Medicine published by John Wiley & Sons Ltd.)

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2024NSFSC1949 Sichuan Natural Science Foundation Youth Foundation Project; ZYJC21046 1.3.5 project for disciplines of excellence, West China Hospital, Sichuan University; 2021HXFH001 1.3.5 project for disciplines of excellence clinical Research Incubation Project, West China Hospital, Sichuan University; 82203782 National Natural Science Foundation of China for Young Scientists Fund; 2022CDSN-18 Sichuan University-Sui Ning School-local Cooperation project; 312230752 China Telecom Sichuan Company Biliary Tract Tumor Big Data Platform and Application Phase I R&D Project; 82203650 National Natural Science Foundation of China for Young Scientists Fund; 2024NSFSC0742 Sichuan Natural Science Foundation

Keywords: functional liver remnant volume; hilar cholangiocarcinoma; liver failure; obstructive jaundice

Date Created: 20240705 Date Completed: 20240705 Latest Revision: 20240707

20250114

PMC11224912

10.1002/cam4.7342

38967142