Vasopressin and fluid retention after liver resection: Comparison with the renin-angiotensin-aldosterone system by surgical extent and liver function

Table 1 Baseline characteristics of the study cohort, mean ± SD/n (%)

Characteristics	All patients (n = 56)
Age (years), median (IQR)	69 (64-75)
Sex (men/women)	37 (66.0)/19 (33.9)
Indication of liver resection
Colorectal liver metastasis	25 (44.6)
Hepatocellular carcinoma	20 (35.7)
Biliary tract cancer	5 (8.9)
Others	6 (10.7)
Indocyanine green retention rate at 15 minutes (%), median (IQR)	10.2 (7.2-14.5)
Kinetic indocyanine green elimination rate constant, median (IQR)	0.155 (0.129-0.177)
Fibrosis-4 index, median (IQR)	1.82 (1.21-3.06)
Albumin-bilirubin scoring	-2.58 ± 0.42
Modified ALBI grade (1/2a/2b/3)	26 (46.4)/18 (32.1)/12 (21.4)/0 (0)
Number of complete resected Couinaud segments, median (IQR)	0 (0-2)
Laparoscopic surgery	22 (39.3)
Extrahepatic bile duct resection	4 (7.1)
Concomitant colorectal resection	3 (5.4)
Operative duration (minutes), median (IQR)	295 (224-379)
Intraoperative blood loss (mL), median (IQR)	333 (100-600)
Intraoperative red blood cell transfusion	11 (19.6)
Intraoperative fluid balance (mL/kg/hour), median (IQR)	8.1 (6.4-11.9)
Preoperative body weight (kg), median IQR	58.2 (52.6-66.4)
Maximum postoperative weight gain (%), median (IQR)	2.7 (1.1-6.4)
Complications (Clavien-Dindo grade ≥ IIIa) (%)	12 (21.4)

IQR: Interquartile range; ALBI: Albumin-bilirubin.

Table 2 Comparison of perioperative variables between patients with normal and impaired liver function, mean ± SD/n (%)

	NL group (n = 27)	IL group (n = 29)	P value
Age (years), median (IQR)	66 (60-74)	71 (68-77)	0.034a
Sex (men/women)	15 (55.6)/12 (44.4)	22 (75.9)/7 (24.1)	0.109
Indication of liver resection			0.003b
Colorectal liver metastasis	16 (59.3)	9 (31.0)
Hepatocellular carcinoma	3 (11.1)	17 (55.6)
Biliary tract cancer	4 (14.8)	1 (3.5)
Others	4 (14.8)	2 (6.9)
Indocyanine green retention rate at 15 minutes (%), median (IQR)	7.2 (6.2-7.8)	14.1 (11.7-18.8)	< 0.001b
Kinetic indocyanine green elimination rate constant, median (IQR)	0.175 (0.170-0.186)	0.131 (0.111-0.143)	< 0.001b
Fibrosis-4 index, median (IQR)	1.46 (1.13-2.38)	2.48 (1.37-4.35)	0.014a
Albumin-bilirubin scoring	-2.69 ± 0.08	-2.49 ± 0.08	0.082
Modified ALBI grade (1/2a/2b)	15 (55.6)/10 (37.0)/2 (7.4)	11(37.9)/8 (27.6)/10 (34.5)	0.047a
Number of complete resected Couinaud segments, median (IQR)	1 (0-2)	0 (0-2)	0.419
Laparoscopic surgery	10 (37.0)	12 (41.1)	0.740
Extrahepatic bile duct resection	2 (7.4)	2 (6.9)	0.941
Concomitant colorectal resection	2 (7.4)	1 (3.5)	0.511
Operative duration (minute), median (IQR)	297 (218-328)	288 (224-384)	0.850
Intraoperative blood loss (mL), median (IQR)	388 (100-641)	290 (83.5-523)	0.774
Intraoperative red blood cell transfusion	5 (18.5)	6 (20.7)	0.838
Intraoperative fluid balance (mL/kg/hour), median (IQR)	8.1 (6.4-12.0)	8.2 (6.6-12.4)	0.844
Preoperative body weight (kg), median (IQR)	57.7 (51.9-71.8)	59.7 (53.3-64.2)	1.000
Maximum postoperative weight gain (%), median (IQR)	2.4 (1.0-6.1)	3.1 (1.5-7.5)	0.403
Complications (Clavien-Dindo grade ≥ IIIa) (%)	4 (14.8)	8 (27.6)	0.245

^aP < 0.05.

^bP < 0.01.

Statistical analyses: Mann-Whitney U test for continuous variables, χ² or Fisher exact test for categorical variables. For normal liver group: Indocyanine green retention rate at 15 minutes (ICG_R15) < 10%, and for impaired liver group: ICG_R15 ≥ 10%. NL: Normal liver; IL: Impaired liver; IQR: Interquartile range; ALBI: Albumin-bilirubin.

Table 3 Comparison of perioperative variables between patients undergoing minor and major liver resection, n (%)

	MinLR group (n = 45)	MajLR group (n = 11)	P value
Age (years), median (IQR)	69 (65-75)	69 (64-77)	0.942
Sex (men/women)	31 (68.9)/14 (31.1)	6 (54.6)/5 (45.5)	0.368
Indication of liver resection			0.053
Colorectal liver metastasis	23 (51.1)	2 (18.2)
Hepatocellular carcinoma	15 (33.3)	5 (45.5)
Biliary tract cancer	2 (4.4)	3 (27.3)
Others	5 (11.1)	1 (9.1)
Indocyanine green retention rate at 15 minutes (%), median (IQR)	10.0 (7.4-17.2)	10.4 (6.2-14.1)	0.458
Kinetic indocyanine green elimination rate constant, median (IQR)	0.155 (0.118-0.173)	0.165 (0.131-0.186)	0.265
Number of complete resected Couinaud segments, median (IQR)	0 (0-1)	3 (3-4)	< 0.001b
Laparoscopic surgery	19 (42.2)	3 (27.3)	0.363
Extrahepatic bile duct resection	0 (0.0)	4 (36.4)	< 0.001b
Concomitant colorectal resection	3 (6.7)	0 (0.0)	0.379
Operative duration (minute), median (IQR)	278 (207-337)	382 (301-665)	0.002b
Intraoperative blood loss (mL), median (IQR)	290 (67-484)	1124 (150-2188)	0.015a
Intraoperative red blood cell transfusion	7 (15.6)	4 (36.4)	0.119
Intraoperative fluid balance (mL/kg/hour), median (IQR)	8.9 (6.8-12.5)	6.9 (4.5-8.8)	0.058
Preoperative body weight (kg), median (IQR)	58.1 (52.2-68.0)	59.7 (54.0-65.0)	0.845
Maximum postoperative weight gain (%), median (IQR)	2.6 (1.2-6.3)	3.5 (1.0-6.4)	0.918
Complications (Clavien-Dindo grade ≥ IIIa) (%)	6 (13.3)	6 (54.6)	0.003b

^aP < 0.05.

^bP < 0.01.

Statistical analyses: Mann-Whitney U test for continuous variables, χ² or Fisher’s exact test for categorical variables. Minor liver resection < 3 Couinaud segments, major liver resection ≥ 3 Couinaud segments (Brisbane 2000 classification). MinLR: Minor liver resection; MajLR: Major liver resection; IQR: Interquartile range.