Article
HA/GSA-Rmax Ratio as a Predictor of Postoperative Liver Failure
Masaki Kaibori,
Sang Kil Ha-Kawa,
Morihiko Ishizaki,
Kosuke Matsui,
Takamichi Saito,
A-Hon Kwon,
Yasuo Kamiyama,
Corresponding Author
Masaki Kaibori
Department of Surgery, Hirakata Hospital, Kansai Medical University, 2-3-1 Shinmachi, 573-1191 Hirakata, Osaka, Japan
[email protected]Search for more papers by this authorSang Kil Ha-Kawa
Department of Radiology, Hirakata Hospital, Kansai Medical University, 2-3-1 Shinmachi, 573-1191 Hirakata, Osaka, Japan
Search for more papers by this authorMorihiko Ishizaki
Department of Surgery, Hirakata Hospital, Kansai Medical University, 2-3-1 Shinmachi, 573-1191 Hirakata, Osaka, Japan
Search for more papers by this authorKosuke Matsui
Department of Surgery, Hirakata Hospital, Kansai Medical University, 2-3-1 Shinmachi, 573-1191 Hirakata, Osaka, Japan
Search for more papers by this authorTakamichi Saito
Department of Surgery, Hirakata Hospital, Kansai Medical University, 2-3-1 Shinmachi, 573-1191 Hirakata, Osaka, Japan
Search for more papers by this authorA-Hon Kwon
Department of Surgery, Hirakata Hospital, Kansai Medical University, 2-3-1 Shinmachi, 573-1191 Hirakata, Osaka, Japan
Search for more papers by this authorYasuo Kamiyama
Department of Surgery, Hirakata Hospital, Kansai Medical University, 2-3-1 Shinmachi, 573-1191 Hirakata, Osaka, Japan
Search for more papers by this authorMasaki Kaibori,
Sang Kil Ha-Kawa,
Morihiko Ishizaki,
Kosuke Matsui,
Takamichi Saito,
A-Hon Kwon,
Yasuo Kamiyama,
Corresponding Author
Masaki Kaibori
Department of Surgery, Hirakata Hospital, Kansai Medical University, 2-3-1 Shinmachi, 573-1191 Hirakata, Osaka, Japan
[email protected]Search for more papers by this authorSang Kil Ha-Kawa
Department of Radiology, Hirakata Hospital, Kansai Medical University, 2-3-1 Shinmachi, 573-1191 Hirakata, Osaka, Japan
Search for more papers by this authorMorihiko Ishizaki
Department of Surgery, Hirakata Hospital, Kansai Medical University, 2-3-1 Shinmachi, 573-1191 Hirakata, Osaka, Japan
Search for more papers by this authorKosuke Matsui
Department of Surgery, Hirakata Hospital, Kansai Medical University, 2-3-1 Shinmachi, 573-1191 Hirakata, Osaka, Japan
Search for more papers by this authorTakamichi Saito
Department of Surgery, Hirakata Hospital, Kansai Medical University, 2-3-1 Shinmachi, 573-1191 Hirakata, Osaka, Japan
Search for more papers by this authorA-Hon Kwon
Department of Surgery, Hirakata Hospital, Kansai Medical University, 2-3-1 Shinmachi, 573-1191 Hirakata, Osaka, Japan
Search for more papers by this authorYasuo Kamiyama
Department of Surgery, Hirakata Hospital, Kansai Medical University, 2-3-1 Shinmachi, 573-1191 Hirakata, Osaka, Japan
Search for more papers by this authorAbstract
Background
Postoperative mortality after hepatectomy remains high compared with other types of surgery in patients who have cirrhosis or chronic hepatitis. Although there are several useful perioperative markers of liver dysfunction, there are no standard markers for predicting postoperative liver failure. This study investigated risk factors for postoperative liver failure after resection of hepatocellular carcinoma to detect markers that could identify candidates for hepatectomy.
Methods
Perioperative risk factors for liver failure after hepatectomy were analyzed in 191 patients with hepatocellular carcinoma. Multivariate logistic regression analysis was done to investigate factors with a significant independent influence among 35 variables. The ratio of serum hyaluronic acid to the maximum removal rate of technetium-99 m diethylenetriaminepentaacetic acid galactosyl human serum albumin (hyaluronate/GSA-Rmax ratio) was calculated.
Results
Liver failure occurred postoperatively in 16 patients, 3 of whom died. The hyaluronate/GSA-Rmax ratio was a risk factor for postoperative liver failure by univariate analysis and was the only risk factor according to multivariate analysis. All three patients who died had a hyaluronic acid/GSA-Rmax ratio ≥ 500 mg min/dl. This ratio had a sensitivity of 88% and a specificity of 92% for predicting liver failure.
Conclusions
To reduce postoperative liver failure, preoperative planning should employ various measures of the hepatic functional reserve, including tests of both parenchymal and nonparenchymal liver function. The hyaluronate/GSA-Rmax ratio can predict liver failure after hepatectomy, and a ratio ≥ 500 mg min/dl is a relative contraindication to liver resection.
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