ArticleLangenbeck's archives of surgery2025
Spleen volume after stage-I associated liver partition and portal vein ligation for staged hepatectomy predicts future liver remnant.
Article in Langenbeck's archives of surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThe spleen has been reported to inhibit liver regeneration following hepatectomy; however, the underlying mechanisms remain poorly understood. In particular, its role in future liver remnant (FLR) regeneration after associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) warrants investigation.
aimTo evaluate the relationship between splenic volume changes and FLR regeneration following ALPPS-stage I in patients with massive hepatocellular carcinoma (HCC).
methodsClinical data from 65 HCC patients who underwent ALPPS between 2018 and 2021 were retrospectively analyzed. Liver and spleen volumes were measured pre- and post-ALPPS-stage I use the IQQA-Liver system. The kinetic growth rate (KGR) of the FLR was calculated. Pearson correlation and logistic regression were used to identify predictors of FLR hypertrophy. Receiver operating characteristic (ROC) curves were constructed to determine cutoff values for splenic predictors.
resultsFollowing ALPPS-stage I, FLR volume significantly increased from 35.57%±8.51-54.31%±11.19% of standard liver volume (SLV) (P < 0.001), with a median KGR of 4.65%/day. Splenic volume also increased (218.65 ± 84.77 cm³ vs. 252.69 cm³, P < 0.001). Preoperative splenic volume and spleen volume/SLV ratio negatively correlated with KGR (r = -0.240, P = 0.027; r = -0.218, P = 0.041). Multivariate analysis identified splenic volume (OR = 0.991, P = 0.043), platelet count (OR = 1.014, P = 0.013), Indocyanine Green Retention Rate at 15 min (ICG-R15) (OR = 0.670, P = 0.010), and CNLC stage (P = 0.001) as independent predictors of FLR regeneration. ROC analysis showed that splenic volume > 265.29 cm³ (AUC = 0.645) and spleen volume/SLV ratio > 0.1997 (AUC = 0.646) predicted poor FLR hypertrophy. One- and two-year survival rates were 80.77% and 68.18%, respectively.
conclusionPreoperative splenic volume is an independent predictor of FLR regeneration after ALPPS. Combined evaluation of splenic volume, platelet count, and liver function may improve patient selection, reduce the risk of postoperative liver failure, and optimize surgical outcomes.
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