Published online Feb 21, 2020. doi: 10.3748/wjg.v26.i7.725
Peer-review started: November 22, 2019
First decision: December 7, 2019
Revised: January 12, 2020
Accepted: January 19, 2020
Article in press: January 19, 2020
Published online: February 21, 2020
Processing time: 90 Days and 17.1 Hours
Liver resection is an effective treatment for benign and malignant liver tumors. However, a method for preoperative evaluation of hepatic reserve has not yet been established. Previously reported assessments of preoperative hepatic reserve focused only on liver failure in the early postoperative period and did not consider the long-term recovery of hepatic reserve.
When determining eligibility for hepatectomy, the underlying pathophysiology needs to be considered to determine if the functional hepatic reserve can withstand both surgery and any postoperative therapy.
To identify pre-hepatectomy factors associated with both early postoperative liver failure and long-term postoperative liver function recovery.
This study was a retrospective cohort study. We retrospectively investigated 215 patients who underwent hepatectomy at our hospital between May 2013 and December 2016. Early post-hepatectomy liver failure (PHLF) was defined using the International Study Group of Liver Surgery’s definition of PHLF. Long-term postoperative recovery of liver function was defined as the time taken for serum total bilirubin and albumin levels to return to levels of < 2 mg/dL and > 2.8 g/dL, respectively, and the time taken for Child-Pugh score to return to Child-Pugh class A.
Preoperative type IV collagen 7S was identified as a significant independent factor associated with both PHLF and postoperative long-term recovery of liver function. Further analysis revealed that the time taken for the recovery of Child-Pugh scores and serum total bilirubin and albumin levels was significantly shorter in patients with type IV collagen 7S ≤ 6 ng/mL than in those with type IV collagen 7S > 6 ng/mL. In additional analyses, similar results were observed in patients without chronic viral hepatitis associated with fibrosis.
Preoperative type IV collagen 7S is a useful predictive factor for early postoperative liver failure and long-term postoperative recovery of liver function. In particular, similar results were obtained in patients without chronic hepatitis virus in the background liver.
Preoperative type IV collagen could be useful in predicting early liver failure and long-term postoperative recovery of liver function in different subsets of patients undergoing hepatectomy in this study. Multicenter and prospective studies are required to investigate the application of preoperative serum type IV collagen 7S levels in predicting the postoperative early liver failure and long-term postoperative recovery of liver function.