The Application Of Preopearive Standard Remnant Liver Volume To Assessment Of Postoperative Liver Failure In Hepatitis B Virus Related Hepatocellular Carcinoma Patietns

Objective: To investigate the relationship between the size of standard remnant liver volume(SRLV) after liver resection and postoperative liver failure in hepatitis B virus(HBV) related hepatocellular carcinoma(HCC) patients.Methods: From July 2014 to October in 2014, 80 patients were diagnosed HBV related HCC and underwent hepatectomy in Affiliated Tumor Hospital of Guangxi Medical University prospectively enrolled in our study. Following parameters were obtained in all patients: total liver volume(TLV), predicted resected liver volume, resected liver volume evaluated by drainage, body surface area(BSA), remnant liver volume(RLV) and SRLV. We compared the liver volume evaluated by Myrian-Liver system software and drainage. Compared analysis of relationship between age, gender, total bilirubin, alanine aminotransferase, aspartate aminotransferase, prothrombin time, albumin,platelet, creatinine, operating time, blood loss, the degree of liver cirrhosis, antiviral therapy, TLV, tumor volume, RLV and SRLV as well as the risk of postoperative liver failure. In addition, patients were divided into 3 groups according to the degree of postoperative liver failure. Therefore to establish the security threshold of SRIV.Results: Liver volume predicted by software has a high relevance with actual liver volume evaluated by drainage(r = 0.984, P < 0.001), among which insignificant difference is found between them(613.5 ml vs. 568.2 ml respectively, t = 0.463, P =0.644). According to the occurrence of postoperative liver failure,the patients were divided into 2 groups: Group A, 54 cases without 1iver failure; Group B, 26 cases with 1iver failure. Statistical analysis showed that the difference of gender, total bilirubin, alanine aminotransferase, aspartate aminotransferase, creatinine, operating time, blood loss, tumor volume, and TLV between Group A and B were insignificant(P>0.05). However, that of age, liver cirrhosis, antiviral therapy, albumin, platelet, RLV and SRLV were significant(P<0.05). The average SRLV in Group A was 534.94 ± 133.10 ml/m2 and 450.06 ± 148.09 ml/m2 in Group B(P<0.05). The security threshold of SRLV was 462 ml/m2 calculated by receiver operating Characteristic(ROC) in our patients. Then randomly selected sixty HCC patients, the incidences of postoperative liver failure in the SRLV≤462 ml/m2 and SRLV>462 ml/m2 patients were 69.7% and 6.4%(P<0.001). Patients suffer postoperative liver failure were devised into three class according to the degree of liver failure: Class A(n=5), Class B(n=20), and Class C(n=1). In patients with class A postoperative liver failure, the security threshold of SRLV was 462 ml/m2. The security threshold of SRLV was 424 ml/m2 in patients with class B postoperative liver failure.Conclusion: The evaluation of TLA, predicted liver resected volume, andRLV conducted by Myrian-Liver system software is efficacy. SRLV is a good predictor for postoperative liver function reserve in HBV related HCC patients.The risk of occurring postoperative liver failure will be high when SPLV≤462 ml/m2. When SPLV≤424 ml/m2, patients would like to suffer Class B postoperative liver failure.