Impact of hepatospleno volume ratio on postoperative chronic liver failure after major hepatectomy for perihilar cholangiocarcinoma

Aims

The incidence of postoperative chronic liver failure (PCLF) after major hepatectomy for perihilar cholangiocarcinoma is relatively low, but it warrants careful attention. This study aimed to analyze the risk factors for PCLF, with a specific focus on the correlation with postoperative changes in liver and spleen volumes.

Methods

A total of 172 patients who underwent major hepatectomy for perihilar cholangiocarcinoma between 2006 and 2021 were included in the study. PCLF is defined as the presence of liver failure, such as ascites, esophageal varices, encephalopathy, and jaundice at 3 mo postoperatively. Risk factors, including chronological changes in liver volume, spleen volume, and hepatospleno volume ratio for PCLF, were evaluated by univariate and multivariate analyses.

Results

PCLF occurred in 8 of the 172 patients. On univariate analysis, multiple factors including preoperative prealbumin levels, indocyanine green retention test, and future remnant liver volume were identified as risk factors for PCLF. On multivariate analysis, the hepatospleno volume ratio (p = 0.033) and prealbumin level (p = 0.015) 3 mo after surgery were significantly associated with PCLF. The cutoff value for the hepatospleno volume ratio was 3.0 (area under the curve [AUC]: 0.881, sensitivity: 91.7%, specificity: 66.7%) and that for prealbumin level was 10 mg/dL (AUC: 0.894, sensitivity: 83.3%, specificity: 88.9%).

Conclusion

Hepatospleno volume ratio <3.0 and prealbumin level <10 mg/dL 3 mo after surgery were identified as risk factors for PCLF, implying the importance of postoperative nutritional guidance to preserve the remnant liver function for patients with these risk factors.