title: Liver stiffness measurement predicts high-grade post-hepatectomy liver failure: A prospective cohort study.
abstract: OBJECTIVE
  Liver stiffness measurement using transient elastography appears to be an excellent tool for detection of liver fibrosis and cirrhosis with high accuracy. The aim of this study is to evaluate the efficacy of preoperative liver stiffness measurement in predicting post-hepatectomy liver failure.
  
  
  METHODS
  A prospective cohort study of all consecutive patients undergoing hepatectomy for hepatocellular carcinoma from February 2010 to August 2014 was studied. All patients received detailed preoperative assessments including liver stiffness measurement. The primary outcome was post-hepatectomy liver failure according to the International Study Group of Liver Surgery definition.
  
  
  RESULTS
  A total of 255 patients were included. Liver stiffness measurement showed significant correlation with grade B or C post-hepatectomy liver failure. (P = 0.003) Using the cutoff at 12 kPa, liver stiffness measurement had a sensitivity of 52.4% and specificity of 73.3% in predication of high-grade (grade B or C) post-hepatectomy liver failure. Liver stiffness measurement > 12 kPa was also an independent prognostic factor for both high-grade post-hepatectomy liver failure and major postoperative complications by multivariate analysis. The diagnostic accuracy was better in patients without right lobe tumor with an area under the receiver operating characteristic of 0.83 compared with an area under the receiver operating characteristic of only 0.62 in patients with right lobe tumor.
  
  
  CONCLUSIONS
  Liver stiffness measurement using Fibroscan is good to predict high-grade post-hepatectomy liver failure especially in patients without right lobe tumor.
authors.affiliation: Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Charing Ching-Ning
authors.initials: CC
authors.lastname: Chong
authors.affiliation: Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China.|Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Grace Lai-Hung
authors.initials: GL
authors.lastname: Wong
authors.affiliation: Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Anthony Wing-Hung
authors.identifier: http://orcid.org/0000-0002-1771-163X
authors.initials: AW
authors.lastname: Chan
authors.affiliation: Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China.|Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Vincent Wai-Sun
authors.initials: VW
authors.lastname: Wong
authors.affiliation: Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Anthony Kwong-Wai
authors.initials: AK
authors.lastname: Fong
authors.affiliation: Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Yue-Sun
authors.initials: YS
authors.lastname: Cheung
authors.affiliation: Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: John
authors.initials: J
authors.lastname: Wong
authors.affiliation: Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Kit-Fai
authors.initials: KF
authors.lastname: Lee
authors.affiliation: Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China.|Department of Clinical Oncology, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Stephen L
authors.initials: SL
authors.lastname: Chan
authors.affiliation: Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China.|Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Paul Bo-San
authors.initials: PB
authors.lastname: Lai
authors.affiliation: Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China.|Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Henry Lik-Yuen
authors.initials: HL
authors.lastname: Chan
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000601:surgery; D015331:Cohort Studies; D054459:Elasticity Imaging Techniques / Q000295:instrumentation; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging*; D017093:Liver Failure / Q000000981:diagnostic imaging*; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D012720:Severity of Illness Index
keywords: Fibroscan; hepatocellular carcinoma; liver stiffness measurement; post-hepatectomy liver failure; transient elastography