Liver regeneration after liver resection: Clinical aspects and correlation with infective complications

Table 1 Type of liver resection performed, according to Couinaud classification n (%)

Patients (n)	Right hepatectomy	Extended right hepatectomy	Left hepatectomy	Left lobectomy
Overall Tumor patients (27)	5 (18.5)	13 (48.1)	8 (29.6)	1 (3.7)
Primary liver tumor (14)	1 (20.0)	7 (46.6)	5 (33.3)	1 (6.7)
Secondary liver tumor (13)	4 (25.0)	6 (50.0)	3 (25.0)	0

Of the 27 patients, 13 had an extended right hepatectomy, 5 a right hepatectomy, 8 a left hepatectomy, and 1 a left lobectomy.

Table 2 Preoperative variables in patients with liver malignancies (n = 27, mean ± SD)

Preoperative factor	Patients with malignancies
Age (yr)	61.04 ± 11.40
Weight (kg)	71.71 ± 12.33
Height (cm)	165.74 ± 8.82
BMI	26.02 ± 3.43
LV (cc)	2036.47 ± 804.95
FRLV (cc)	701.45 ± 343.56
Bilirubin (mg/dL)	0.88 ± 1.86
ALT (u/L)	57.26 ± 33.14
Albumin (g/dL)	3.44 ± 0.67
AST (u/L)	45.78 ± 38.28
Creatinine(mg/dL)	0.94 ± 0.24
GGT (u/L)	179. 33 ± 164.98
Platelet (103/μL)	278.96 ± 107.22
Prothrombin time (%)	95.93 ± 21.56
INR	1.05 ± 0.14
Steatosis (Hounsfield units)	1.10 ± 0.18
Portal vein diameter (mm)	13.83 ± 2.01
SV (cc)	315.38 ± 129.06
Glucose (mg/dL)	110.19 ± 38.08
Numbers of resected liver segments	4.67 ± 1.07

Steatosis was measured using the Hounsfield units of the liver from a basal CT scan and using the spleen Hounsfield unit as a reference value. Portal hypertension was measured indirectly by measuring the diameter of the common portal vein on portal venous phase images. BMI: Body mass index; LV: Liver volume; FRLV: Future remnant liver volume; ALT: Alanine aminotransferases; AST: Aspartate aminotransferases; GGT: Gamma-glutamyl transpeptidase; INR: International normalized ratio; SV: Spleen volume.

Table 3 Postoperative variables in minor and major regeneration groups after 6 d (mean ± SD)

Post-surgical factors	Minor liver regeneration	Major regeneration	P value
Total bilirubin (mg/dL)	2.37 ± 4.75	2.99 ± 4.68	0.745
Direct bilirubin (mg/dL)	1.44 ± 2.78	2.13 ± 3.64	0.586
Albumin (g/dL)	2.73 ± 0.67	2.76 ± 0.51	0.912
Creatinine (mg/dL)	0.89 ± 0.41	0.92 ± 0.27	0.817
Prothrombin time (%)	81.58 ± 25.84	80.61 ± 17.16	0.917
PT/INR	1.41 ± 0.71	1.16 ± 0.21	0.306

Table 4 Onset and severity of complications within 90 d of surgery, and grouped within the five tiers of the Clavien–Dindo classification

GRADE	< 100	> 100	Total
Onset1
0	4	3	7
1	3	1	4
2	3	1	4
3a	1	1	2
3b	5	3	8
4	0	0	-
5	1	1	2
Total	17	10	27
Severity2
3a	1	1	2
3b	5	3	8
4	0	0	-
5	1	1	2
Total	7	5	12

¹Fisher's exact test - P value > 0.999;

²Fisher's exact test - P value > 0.999.

Table 5 Preoperative factors, adjusted for follow-up time, associated with early liver regeneration in 27 patients with hepatic tumor (stepwise multiple generalized linear regression)

Preoperative factors	Coefficient	SE	P value	95%CI
FRLV	-0.00232	0.00054	< 0.001	(-0.00337 - -0.00127)
SV/FRLV	0.49988	0.20731	0.016	(0.09357-0.90619)
Follow-up time	0.00704	0.00232	0.002	(0.00249-0.01159)

The future remnant liver volume, body habitus, and spleen volume proved to be markers of optimal early liver regeneration. LV: Liver volume; FRLV: Future remnant liver volume; SV: Spleen volume.

Table 6 Generalized linear regression analysis of factors influencing liver regeneration, adjusted for follow-up time

Preoperative factors	Coefficient	P value	95%CI
FRLV	-0.0027	< 0.001	(-0.0036- -0.0018)
BMI	-0.1155	< 0.001	(-0.1763- -0.0548)
SV/FRLV	1.0925	< 0.001	(0.7356-1.4494)
Bilirubin	-0.0885	0.547	(-0.3762-0.1993)
Albumin	0.0003	0.999	(-0.3945-0.3951)
GGT	0	0.993	(-0.0016-0.0016)
Creatinine	0.7841	0.194	(-0.4001-1.9683)
INR	0.7054	0.435	(-1.0666-2.4775)
Age	-0.0032	0.744	(-0.0224-0.0160)
Steatosis (Hounsfield units)	0.1326	0.857	(-1.3137-1.5788)
HAIs	0.2739	0.402	(0.3661-0.9141)

BMI: Body mass index; LV: Liver volume; FRLV: Future remnant liver volume; GGT: Gamma-glutamyl transpeptidase; INR: International normalized ratio; SV: Spleen volume; HAIs: Healthcare-associated infections.