HPB : the official journal of the International Hepato Pancreato Biliary Association · 2026
Safe major hepatectomy in HCC patients with remnant-to-standard liver volume below 40% and preserved ICG clearance.
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Dang Viet Q, Pham Phu H, Vo Thinh Q, Nguyen Thanh Q, Ha Hung Q, Nguyen Bac H
Аннотация
BACKGROUND: A future liver remnant (FLR) ≥40% is commonly recommended for major hepatectomy in patients with chronic liver disease; however, volumetry alone may not adequately reflect functional reserve. We evaluated whether FLR <40% increases posthepatectomy liver failure (PHLF) in hepatocellular carcinoma (HCC).
METHODS: This retrospective study included 269 consecutive patients who underwent major hepatectomy for HCC between October 2016 and December 2024. Patients were stratified into FLR <40% (n = 84) and FLR ≥40% (n = 185). Clinically relevant PHLF was defined as ISGLS grade B-C, and liver failure was also assessed using the 50-50 criteria. Propensity score matching (1:2) and inverse probability of treatment weighting (IPTW) were performed.
RESULTS: ISGLS grade B-C PHLF occurred more frequently in the FLR <40% group in unadjusted (13.1% vs 3.8%), matched (15.9% vs 1.7%), and IPTW analyses (16.4% vs 3.5%). In contrast, liver failure defined by the 50-50 criteria did not differ between groups. Postoperative mortality and length of hospital stay were comparable.
CONCLUSION: FLR <40% is associated with increased ISGLS-defined PHLF but not with PHLF defined by the 50-50 criteria, mortality, or prolonged hospitalization in patients with preserved functional reserve.
METHODS: This retrospective study included 269 consecutive patients who underwent major hepatectomy for HCC between October 2016 and December 2024. Patients were stratified into FLR <40% (n = 84) and FLR ≥40% (n = 185). Clinically relevant PHLF was defined as ISGLS grade B-C, and liver failure was also assessed using the 50-50 criteria. Propensity score matching (1:2) and inverse probability of treatment weighting (IPTW) were performed.
RESULTS: ISGLS grade B-C PHLF occurred more frequently in the FLR <40% group in unadjusted (13.1% vs 3.8%), matched (15.9% vs 1.7%), and IPTW analyses (16.4% vs 3.5%). In contrast, liver failure defined by the 50-50 criteria did not differ between groups. Postoperative mortality and length of hospital stay were comparable.
CONCLUSION: FLR <40% is associated with increased ISGLS-defined PHLF but not with PHLF defined by the 50-50 criteria, mortality, or prolonged hospitalization in patients with preserved functional reserve.