Department of Gastrointestinal and Hepatobiliary-Pancreatic Surgery, University of Tsukuba, Tsukuba 3058-575, Ibaraki, Japan.
Department of Biostatistics, University of Tsukuba, Tsukuba 3058-575, Ibaraki, Japan.
World J Gastroenterol. 2024 Apr 14;30(14):2006-2017. doi: 10.3748/wjg.v30.i14.2006.
The success of liver resection relies on the ability of the remnant liver to regenerate. Most of the knowledge regarding the pathophysiological basis of liver regeneration comes from rodent studies, and data on humans are scarce. Additionally, there is limited knowledge about the preoperative factors that influence postoperative regeneration.
To quantify postoperative remnant liver volume by the latest volumetric software and investigate perioperative factors that affect posthepatectomy liver regeneration.
A total of 268 patients who received partial hepatectomy were enrolled. Patients were grouped into right hepatectomy/trisegmentectomy (RH/Tri), left hepatectomy (LH), segmentectomy (Seg), and subsegmentectomy/nonanatomical hepatectomy (Sub/Non) groups. The regeneration index (RI) and late regeneration rate were defined as (postoperative liver volume)/[total functional liver volume (TFLV)] × 100 and (RI at 6-months - RI at 3-months)/RI at 6-months, respectively. The lower 25 percentile of RI and the higher 25 percentile of late regeneration rate in each group were defined as "low regeneration" and "delayed regeneration". "Restoration to the original size" was defined as regeneration of the liver volume by more than 90% of the TFLV at 12 months postsurgery.
The numbers of patients in the RH/Tri, LH, Seg, and Sub/Non groups were 41, 53, 99 and 75, respectively. The RI plateaued at 3 months in the LH, Seg, and Sub/Non groups, whereas the RI increased until 12 months in the RH/Tri group. According to our multivariate analysis, the preoperative albumin-bilirubin (ALBI) score was an independent factor for low regeneration at 3 months [odds ratio (OR) 95%CI = 2.80 (1.17-6.69), = 0.02; per 1.0 up] and 12 months [OR = 2.27 (1.01-5.09), = 0.04; per 1.0 up]. Multivariate analysis revealed that only liver resection percentage [OR = 1.03 (1.00-1.05), = 0.04] was associated with delayed regeneration. Furthermore, multivariate analysis demonstrated that the preoperative ALBI score [OR = 2.63 (1.00-1.05), = 0.02; per 1.0 up] and liver resection percentage [OR = 1.02 (1.00-1.05), = 0.04; per 1.0 up] were found to be independent risk factors associated with volume restoration failure.
Liver regeneration posthepatectomy was determined by the resection percentage and preoperative ALBI score. This knowledge helps surgeons decide the timing and type of rehepatectomy for recurrent cases.
肝切除术的成功依赖于剩余肝脏的再生能力。大多数关于肝再生病理生理学基础的知识来自于啮齿动物的研究，而关于人类的数据则相对较少。此外，关于影响肝切除术后再生的术前因素的了解也很有限。
使用最新的容积软件定量评估术后剩余肝脏体积，并探讨影响肝切除术后肝再生的围手术期因素。
共纳入 268 例接受部分肝切除术的患者。将患者分为右半肝/三叶切除术（RH/Tri）、左半肝切除术（LH）、肝段切除术（Seg）和亚肝段/非解剖性肝切除术（Sub/Non）组。再生指数（RI）和晚期再生率定义为（术后肝脏体积）/[总功能性肝体积（TFLV）]×100 和（6 个月时的 RI-3 个月时的 RI）/6 个月时的 RI，分别为。每个组中 RI 的下 25 百分位数和晚期再生率的上 25 百分位数定义为“低再生”和“延迟再生”。“恢复到原始大小”定义为术后 12 个月时肝脏体积再生超过 TFLV 的 90%。
RH/Tri、LH、Seg 和 Sub/Non 组的患者数量分别为 41、53、99 和 75 例。LH、Seg 和 Sub/Non 组的 RI 在 3 个月时达到平台期，而 RH/Tri 组的 RI 则一直增加到 12 个月。根据我们的多变量分析，术前白蛋白-胆红素（ALBI）评分是 3 个月时低再生的独立因素[优势比（OR）95%CI=2.80（1.17-6.69），=0.02；每增加 1.0 个单位]和 12 个月时低再生的独立因素[OR=2.27（1.01-5.09），=0.04；每增加 1.0 个单位]。多变量分析显示，只有肝切除百分比[OR=1.03（1.00-1.05），=0.04]与延迟再生相关。此外，多变量分析表明，术前 ALBI 评分[OR=2.63（1.00-1.05），=0.02；每增加 1.0 个单位]和肝切除百分比[OR=1.02（1.00-1.05），=0.04；每增加 1.0 个单位]是与体积恢复失败相关的独立危险因素。
肝切除术后的肝再生由切除百分比和术前 ALBI 评分决定。这些知识有助于外科医生决定复发性病例再次肝切除术的时机和类型。
