Delayed Liver Function Recovery After Right Hepatectomy for Metastatic Liver Tumors: Incidence, Risk Factors, and Impact on Prognosis.

Abstract

Systemic therapy, including liver resection, is crucial for treating metastatic liver tumors. Even when radical resection is successful, early recurrence of advanced or metastatic liver tumors may restrict subsequent treatment options, particularly if delayed liver function recovery (DLFR) occurs after hepatectomy. This study focused on DLFR after right hepatectomy for metastatic liver tumors. This study involved a retrospective analysis of 78 patients who underwent right hepatectomy for metastatic liver tumors between 2007 and 2022. DLFR was defined as a modified albumin-bilirubin (mALBI) grade that was lower than that preoperatively or ≤ 2b at 3 months after surgery. Patient characteristics, surgical outcomes, and perioperative factors were compared between patients with and without DLFR. Overall survival (OS) was also assessed in patients with colorectal liver metastases. The median age was 63, and 6 patients had ASA-PS ≥ 3. Of the primary tumors, 67 were colorectal cancer. The median preoperative indocyanine green retention rate at 15 min (ICG-R15) was 5.8%, and sarcopenia was present in 23 patients. Eight patients had complications of Clavien-Dindo grade ≥ 3a classification. DLFR occurred in 24 patients (30.7%). Univariate analysis identified ASA-PS ≥ 3, ICG-R15 ≥ 10%, sarcopenia, and grade ≥ 3a complications as significant factors. Multivariate analysis found ICG-R15 ≥ 10% (p = 0.021, HR = 4.352) and sarcopenia (p = 0.035, HR = 3.852) to be the predictors of DLFR. Three-year OS was worse in the DLFR group (p < 0.001). Approximately 30% of patients developed DLFR following right hepatectomy. DLFR may adversely affect OS, and this risk should be carefully considered, particularly in patients with ICG-R15 > 10% or sarcopenia.