European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology · 2026
Volumetric discordance predicts post-hepatectomy liver failure after major hepatectomy: the false security of measured volumetry.
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Ding Shijie, Tong Haihang, Xu Zhenghao, Gao Yu-Lin, Jin Liming, Shen Guo-Liang, Liu Junwei, Huang Jing, Yao Weifeng, Xiao Zun-Qiang
Аннотация
BACKGROUND: Standard total liver volume (STLV) equations derived from Western populations may not perform well in Chinese patients. We developed a China-specific STLV equation and evaluated whether discordance between standardized and measured FLR ratios is associated with post-hepatectomy liver failure (PHLF) after major hepatectomy.
METHODS: In this retrospective study (March 2017-June 2025), we derived an STLV equation in patients with a normal liver background and internally validated it against the Vauthey equation. In the major hepatectomy cohort, volumetry was obtained from preoperative MRI and postoperative CT. Volumetric discordance was defined as the difference between standardized and measured FLR ratios (Δ), with Δ ≈ 0.08 used for stratified analyses.
RESULTS: Among 971 patients, overall PHLF was higher in the abnormal-background group, while grade B/C PHLF was similar between groups. The China-specific STLV equation showed lower error and reduced systematic bias versus the Vauthey equation. In the major hepatectomy cohort (Group A n = 65; Group B n = 185; Group C n = 118), overall PHLF occurred in 27.4% and was most frequent in Group A. After adjustment for Child-Pugh grade and ICGR15, the discordance pattern Δ > 0.08 with sFLRV < mFLRV (Group A) remained associated with PHLF (OR 2.54, 95% CI 1.41-4.57). Δ alone had limited discrimination, but performance improved when combined with liver function variables in a multivariable model.
CONCLUSIONS: A locally calibrated STLV equation reduces bias in volume standardization. Discordance where standardized FLRV is lower than measured FLRV is associated with higher PHLF risk after major hepatectomy and may refine preoperative risk stratification alongside functional markers.
METHODS: In this retrospective study (March 2017-June 2025), we derived an STLV equation in patients with a normal liver background and internally validated it against the Vauthey equation. In the major hepatectomy cohort, volumetry was obtained from preoperative MRI and postoperative CT. Volumetric discordance was defined as the difference between standardized and measured FLR ratios (Δ), with Δ ≈ 0.08 used for stratified analyses.
RESULTS: Among 971 patients, overall PHLF was higher in the abnormal-background group, while grade B/C PHLF was similar between groups. The China-specific STLV equation showed lower error and reduced systematic bias versus the Vauthey equation. In the major hepatectomy cohort (Group A n = 65; Group B n = 185; Group C n = 118), overall PHLF occurred in 27.4% and was most frequent in Group A. After adjustment for Child-Pugh grade and ICGR15, the discordance pattern Δ > 0.08 with sFLRV < mFLRV (Group A) remained associated with PHLF (OR 2.54, 95% CI 1.41-4.57). Δ alone had limited discrimination, but performance improved when combined with liver function variables in a multivariable model.
CONCLUSIONS: A locally calibrated STLV equation reduces bias in volume standardization. Discordance where standardized FLRV is lower than measured FLRV is associated with higher PHLF risk after major hepatectomy and may refine preoperative risk stratification alongside functional markers.