Intraoperatively measured prehepatectomy portal vein pressure as a useful predictor of postoperative liver failure

Abstract

Background Predicting posthepatectomy liver failure (PLF) may be a critical requirement for liver disease patients undergoing hepatectomy. This study retrospectively analyzed the impact of the intraoperatively measured portal vein pressure (PVP) prior to hepatectomy on the prediction of PLF in hepatectomized patients. Methods A total of 334 hepatectomized patients in whom the PVP was intraoperatively measured before resection at our institution were enrolled in the present study. Outcomes were assessed according to the International Study Group of Liver Surgery definition and the severity of PLF grading. Results Thirty-nine of the 334 patients (11.6%) developed grade B/C PLF. The following factors were significantly associated with grade B/C PLF in a univariate analysis: indocyanine green retention rate after 15 minutes, Child-Pugh score, prehepatectomy PVP, and transfusion (each P < 0.0001). A prehepatectomy PVP value of 19.5 cmH₂O was the optimal cutoff value for predicting grade B/C PLF. In a multivariate analysis, prehepatectomy PVP (≥ 19.5 cmH₂O) was selected as the most relevant risk factor for grade B/C PLF (P = 0.0003, hazard ratio: 5.96, 95% CI: 1.80–19.70). Conclusions Prehepatectomy PVP can serve as a useful predictor of the risk of PLF in patients who have undergone hepatectomy. The results emphasize the possibility of reducing the planned extent of hepatic resection when the prehepatectomy PVP value measured intraoperatively exceeds 19.5 cmH₂O, and the importance of predicting the PVP before the operation.