Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, Tsu, Japan.
Langenbecks Arch Surg. 2023 Aug 7;408(1):297. doi: 10.1007/s00423-023-03025-w.
The study aimed at retrospectively assessing the impact of spleen volume (SpV) on the development of posthepatectomy liver failure (PHLF) in patients who underwent hepatectomy for hepatocellular carcinoma (HCC).
152 patients with primary HCC who underwent hepatectomy (sectionectomy or more) were classified into PHLF and non-PHLF groups, and then the relationship between PHLF and SpV was assessed. SpV (cm) was obtained from preoperative CT and standardized based on the patient's body surface area (BSA, m).
PHLF was observed in 39 (26%) of the 152 cases. SpV/BSA was significantly higher in the PHLF group, and the postoperative 1-year survival rate was significantly worse in the PHLF group than that in the non-PHLF group (p = 0.044). Multivariable analysis revealed SpV/BSA as a significant independent risk factor for PHLF. Using the cut-off value (160 cm/m), the 152 cases were divided into small SpV and large SpV groups. The incidence of PHLF was significantly higher in the large SpV group (p = 0.002), the liver failure-related mortality rate was also significantly higher in the large SpV group (p = 0.007), and the 1-year survival rate was significantly worse in the large SpV group (p = 0.035).
These results suggest SpV as a predictor of PHLF and short-term mortality in patients who underwent hepatectomy for HCC. Moreover, SpV measurement is a simple and potentially useful method for predicting PHLF in patients with HCC.
本研究旨在回顾性评估脾脏体积（SpV）对肝细胞癌（HCC）患者行肝切除术后发生肝切除术后肝功能衰竭（PHLF）的影响。
将 152 例接受肝切除术（部分切除术或以上）的原发性 HCC 患者分为 PHLF 组和非 PHLF 组，然后评估 PHLF 与 SpV 的关系。SpV（cm）通过术前 CT 获得，并基于患者的体表面积（BSA，m）进行标准化。
152 例中观察到 39 例（26%）发生 PHLF。PHLF 组 SpV/BSA 显著升高，PHLF 组术后 1 年生存率显著低于非 PHLF 组（p=0.044）。多变量分析显示 SpV/BSA 是 PHLF 的独立显著危险因素。使用截断值（160 cm/m），将 152 例患者分为小 SpV 和大 SpV 组。大 SpV 组 PHLF 发生率显著升高（p=0.002），大 SpV 组肝功能衰竭相关死亡率也显著升高（p=0.007），大 SpV 组 1 年生存率显著降低（p=0.035）。
这些结果表明 SpV 是预测 HCC 患者行肝切除术后 PHLF 和短期死亡率的指标。此外，SpV 测量是预测 HCC 患者 PHLF 的一种简单且具有潜在应用价值的方法。
