• Surgery · Feb 2016

    Clinical Trial

    Prediction of posthepatectomy liver failure based on liver stiffness measurement in patients with hepatocellular carcinoma.

    • Takahiro Nishio, Kojiro Taura, Yukinori Koyama, Kazutaka Tanabe, Gen Yamamoto, Yukihiro Okuda, Yoshinobu Ikeno, Satoru Seo, Kentaro Yasuchika, Etsuro Hatano, Hideaki Okajima, Toshimi Kaido, Shiro Tanaka, and Shinji Uemoto.
    • Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
    • Surgery. 2016 Feb 1; 159 (2): 399-408.

    BackgroundPosthepatectomy liver failure (PHLF) is a potentially fatal complication, and the accurate prediction of PHLF is essential. Liver stiffness measurement (LSM) has been accepted widely as a noninvasive assessment for liver fibrosis. We aimed to evaluate the usefulness of LSM in predicting PHLF.MethodsOne hundred seventy-seven patients with hepatocellular carcinoma who underwent liver resection between August 2011 and October 2014 were analyzed prospectively. LSM was performed by Virtual Touch Tissue Quantification based on acoustic radiation force impulse imaging, and its value was expressed as the shear wave velocity (Vs) [m/s]. The remnant liver volume rate (Rem) was calculated by computed tomography volumetry. PHLF was diagnosed on the basis of the definition from the International Study Group of Liver Surgery.ResultsPHLF occurred in 38 patients (21.5%): grade A, 17 patients (9.6%); grade B, 15 patients (8.5%); and grade C, 6 patients (3.4%). The area under the receiver operating characteristic curve of the Vs for predicting PHLF was 0.67 for grade ≥A, 0.78 for grade ≥B, and 0.74 for grade C, which was greater than any other preoperative factor for each grade. Multivariate stepwise selection identified 2 significant factors associated with PHLF grade ≥B: Vs (odds ratio, 2.66; 95% confidence interval, 1.69-4.41, P < .01) and Rem (odds ratio, 0.47; 95% confidence interval, 0.27-0.79, P < .01). The logistic model that included the Vs and Rem resulted in an area under the receiver operating characteristic curve of 0.80 for predicting PHLF grade ≥B.ConclusionLSM was useful for the prediction of PHLF and the estimation of the safe Rem range.Copyright © 2016 Elsevier Inc. All rights reserved.

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