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Risk factors of posthepatectomy liver failure for perihilar cholangiocarcinoma
Author(s) -
Lee Jong W.,
Lee Jae H.,
Park Yejong,
Lee Woohyung,
Kwon Jaewoo,
Song Ki B.,
Hwang Dae W.,
Kim Song C.
Publication year - 2020
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.25974
Subject(s) - medicine , hepatectomy , liver failure , indocyanine green , gastroenterology , risk factor , incidence (geometry) , bile duct , hepatocellular carcinoma , receiver operating characteristic , resection , surgery , physics , optics
Abstract Background Surgery for perihilar cholangiocarcinoma (PHCC) is associated with high morbidity. This study aimed to investigate the clinical value of the future liver remnant volume‐to‐body weight (FLRV/BW) and propose a risk score for predicting the risk of patients with PHCC developing posthepatectomy liver failure (PHLF). Methods This study included 348 patients who underwent major hepatectomy with bile duct resection for PHCC during 2008‐2015 at a single center in Korea and they were retrospectively analyzed. Results Clinically relevant PHLF was noted in 40 patients (11.4%). The area under the curve (AUC) for FLRV/BW was not significantly different from that for FLRV/total liver volume ( P = .803) or indocyanine green clearance of the future liver remnant ( P = .629) in terms of predicting PHLF. On multivariate analysis, predictors of PHLF ( P < .05) were male sex, albumin less than 3.5 g/dL, preoperative cholangitis, portal vein resection, FLRV/BW less than 0.5%, and FLRV/BW 0.5% to 0.75%. These variables were included in the risk score that showed good discrimination (AUC, 0.853; 95% CI, 0.802‐0.904). It will help rank patients into three risk subgroups with a predicted liver failure incidence of 4.75%, 18.73%, and 51.58%, respectively. Conclusions FLRV/BW is a comparable risk prediction factor of PHLF and the proposed risk score can help to predict the risk of planned surgery in PHCC.