Current status of preoperative risk assessment for posthepatectomy liver failure in patients with hepatocellular carcinoma

Abstract

Liver resection is an effective therapeutic option for patients with hepatocellular carcinoma. However, posthepatectomy liver failure (PHLF) remains a major cause of hepatectomy‐related mortality, and the accurate prediction of PHLF based on preoperative assessment of liver functional reserve is a critical issue. The definition of PHLF proposed by the International Study Group for Liver Surgery has gained acceptance as a standard grading criterion. Liver function can be estimated using a variety of parameters, including routine blood biochemical examinations, clinical scoring systems, dynamic liver function tests, liver stiffness and fibrosis markers, and imaging studies. The Child–Pugh score and model for end‐stage liver disease scores are conventionally used for estimating liver decompensation, although the alternatively developed albumin‐bilirubin score shows superior performance for predicting hepatic dysfunction. Indocyanine green clearance, a dynamic liver function test mostly used in Japan and other Asian countries, serves as a quantitative estimation of liver function reserve and helps determine indications for surgical procedures according to the estimated risk of PHLF. In an attempt to improve predictive accuracy, specific evaluation of liver fibrosis and portal hypertension has gained popularity, including liver stiffness measurements using ultrasonography or magnetic resonance elastography, as well as noninvasive fibrosis markers. Imaging modalities, including Tc‐99m‐labeled galactosyl serum albumin scintigraphy and gadolinium‐enhanced magnetic resonance imaging, are used for preoperative evaluation in combination with liver volume. This review aims to provide an overview of the usefulness of current options for the preoperative assessment of liver function in predicting PHLF.

Major liver resections, perioperative issues and posthepatectomy liver failure: A comprehensive update for the anesthesiologist

“…Algorithms using R15 indocyanine green (ICG) values (R15 ICG > 15% indicating a risk of PHLF) remain important predictors of short- and long-term mortality after liver resections for HCC. Clinical (CP, MELD, ALBI, APRI+ALBI) and functional assessments of FLR with imaging or dynamic techniques are well-established, but their application varies among centers[ 42 , 149 , 151 - 156 ].…”

Predicting liver function after hemihepatectomy in patients with hepatocellular carcinoma using different modalities

“…Second, while the authors employed a multivariable logistic regression model to evaluate the association between LSM value, SRLV, and postoperative liver dysfunction, they failed to address potential confounding factors or mitigate biases in their analysis model. It's recommended that relevant factors previously shown to be linked to the outcome variable, postoperative liver dysfunction, in the literature should be considered in the modeling analysis phase, where applicable[ 2 - 4 ]. This comprehensive approach would strengthen the study's validity and provide a more robust foundation for interpreting its findings.…”

Significance of Prediction Models for Post-Hepatectomy Liver Failure Based on Type IV Collagen 7s Domain in Patients with Hepatocellular Carcinoma

“…Precise assessment of the risk of PHLF is an important clinical issue. Several risk factors for PHLF have been reported, such as the extent of liver resection, Child-Pugh class, Fibrosis-4 (FIB-4) index, albumin-bilirubin (ALBI) score, indocyanine green (ICG) retention rate at 15 min (ICG15R), advanced fibrosis staging of the background liver, and increased hepatitis activity [5][6][7][8]. Previous studies have attempted to establish predictive models for PHLF in patients with HCC who have undergone liver resection [9][10][11].…”