title: Remnant liver volume-based predictors of postoperative liver dysfunction after hepatectomy: analysis of 625 consecutive patients from a single institution.
abstract: BACKGROUND
  During hepatic resection, accurate estimation of remnant liver volume and hepatic function is crucial for avoiding postoperative liver failure. The purpose of this study was to identify preoperative factors related to postoperative liver dysfunction according to the percentage of future liver remnant volume (%FLR).
  
  
  METHODS
  A total of 625 patients who underwent hepatectomy were enrolled in this study. Total bilirubin level >50 μmol/L and/or prothrombin time index <50 % on postoperative day 5 were used as criteria for postoperative liver dysfunction (PLD). Patients were classified into 3 groups according to the %FLR: 35-60 (n = 116), 60-80 (n = 157), and >80 (n = 351). Multivariate logistic regression analysis was performed to identify factors related to postoperative liver dysfunction in each group.
  
  
  RESULTS
  Among the patients with 35-80 %FLR, the morbidity and mortality rates were significantly higher in patients with PLD than in patients without PLD. There was no postoperative death in patients with >80 %FLR . Multivariate analysis showed that PLD was associated with receptor index (LHL15) ≤0.93 (odds ratio [OR] = 7.96) in patients with 35-60 %FLR. The sensitivity and specificity for PLD were 87.5 and 96.1 %, respectively. In patients with 60-80 %FLR, PLD was associated with platelet count <10.0 × 10(4)/mL (OR = 6.12). The sensitivity and specificity for PLD were 73.3 and 96.2 %, respectively.
  
  
  CONCLUSIONS
  LHL15 ≤0.93 and platelet count <10.0 × 10(4)/mL are pivotal indicators for predicting PLD in patients with 35-60 %FLR and 60-80 %FLR, respectively.
authors.affiliation: Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan, hirohisaokabe1251@yahoo.co.jp.
authors.forename: Hirohisa
authors.initials: H
authors.lastname: Okabe
authors.forename: Toru
authors.initials: T
authors.lastname: Beppu
authors.forename: Akira
authors.initials: A
authors.lastname: Chikamoto
authors.forename: Hiromitsu
authors.initials: H
authors.lastname: Hayashi
authors.forename: Morikatsu
authors.initials: M
authors.lastname: Yoshida
authors.forename: Toshiro
authors.initials: T
authors.lastname: Masuda
authors.forename: Katsunori
authors.initials: K
authors.lastname: Imai
authors.forename: Kosuke
authors.initials: K
authors.lastname: Mima
authors.forename: Shigeki
authors.initials: S
authors.lastname: Nakagawa
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Kuroki
authors.forename: Hidetoshi
authors.initials: H
authors.lastname: Nitta
authors.forename: Takatoshi
authors.initials: T
authors.lastname: Ishiko
authors.forename: Daisuke
authors.initials: D
authors.lastname: Hashimoto
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Yamashita
authors.forename: Hideo
authors.initials: H
authors.lastname: Baba
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D005260:Female; D018530:Gastric Stump / Q000473:pathology*; D006498:Hepatectomy / Q000009:adverse effects; D006801:Humans; D008107:Liver Diseases / Q000401:mortality* / Q000473:pathology; D008113:Liver Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000473:pathology / Q000601:surgery; D011183:Postoperative Complications / Q000401:mortality* / Q000473:pathology