Predictors of Post-Hepatectomy Liver Failure in Klatskin Tumors: The Role of Preoperative Glucose, Future Liver Remnant to Spleen Ratio, and Early Bilirubin Monitoring
Suyeon Kim,
Hyung June Ku,
Hyung Hwan Moon,
Sang Hwa Song,
Young Il Choi,
Dong Hoon Shin,
Yang Seok Koh,
Namkee Oh,
Jinsoo Rhu,
Garam Lee,
Won Jong Yang,
Junho Song,
Chol Min Kang,
Seoyeong Ku,
Amy Choi
Affiliations
Suyeon Kim
Department of Information Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
Hyung June Ku
Chang Kee-Ryo Memorial Liver Institute, Kosin University College of Medicine, Busan 49267, Republic of Korea
Hyung Hwan Moon
Chang Kee-Ryo Memorial Liver Institute, Kosin University College of Medicine, Busan 49267, Republic of Korea
Sang Hwa Song
Division of Hepatobiliary-Pancreas Surgery, Department of Surgery, Chonnam National University Hwasun Hospital, Hwasun 58128, Republic of Korea
Young Il Choi
Chang Kee-Ryo Memorial Liver Institute, Kosin University College of Medicine, Busan 49267, Republic of Korea
Dong Hoon Shin
Chang Kee-Ryo Memorial Liver Institute, Kosin University College of Medicine, Busan 49267, Republic of Korea
Yang Seok Koh
Division of Hepatobiliary-Pancreas Surgery, Department of Surgery, Chonnam National University Hwasun Hospital, Hwasun 58128, Republic of Korea
Namkee Oh
Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
Jinsoo Rhu
Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
Garam Lee
Chang Kee-Ryo Memorial Liver Institute, Kosin University College of Medicine, Busan 49267, Republic of Korea
Won Jong Yang
Computer Science Department, Silver Center for Arts and Science, New York University, New York, NY 10010, USA
Junho Song
College of Medicine, Pennsylvania State University, Hershey, PA 17033, USA
Chol Min Kang
Department of Applied Biomedical Engineering, The Johns Hopkins University, Baltimore, MD 21287, USA
Seoyeong Ku
Chang Kee-Ryo Memorial Liver Institute, Kosin University College of Medicine, Busan 49267, Republic of Korea
Amy Choi
Department of Neurobiology, Columbia University, New York, NY 10027, USA
Background: Post-hepatectomy liver failure (PHLF) is a serious complication following hepatic resection for Klatskin tumors, significantly affecting patient prognosis. Identifying reliable preoperative and early postoperative predictors of PHLF can help optimize patient outcomes and guide surgical planning. Method: We conducted a retrospective review of 34 patients who underwent hemi-hepatectomy for extrahepatic cholangiocarcinoma at Kosin University Gospel Hospital between April 2019 and April 2024, and at Chonnam National University Hwasun Hospital between September 2017 and April 2024. Demographics, laboratory data, and volumetric measurements including spleen volume, were analyzed to assess their roles in predicting PHLF. Logistic regression and receiver operating characteristic (ROC) curve analyses were performed to evaluate the predictive value of these factors. Results: Elevated preoperative glucose levels and reduced future liver remnant to spleen ratio (FLR/SV) were significantly associated with an increased risk of PHLF. Additionally, elevated postoperative day 1 total bilirubin (POD 1 TB) was identified as a key postoperative predictor of PHLF. Multivariable analysis confirmed the significance of these factors, with FLR/SV, preoperative glucose, and POD 1 TB demonstrating good discriminative ability in ROC analysis, with AUC values of 0.779, 0.782, and 0.786 respectively. Conclusion: Preoperative glucose control, evaluation of FLR/SV, and early postoperative monitoring of TB are useful for improving outcomes in patients undergoing major hepatectomy for Klatskin tumors.
