ArticleSurgery today2026
Postoperative liver function trajectories and risk factors after hepatectomy for hepatocellular carcinoma.
Article in Surgery today, 2026. 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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16 authors.
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Abstract
purposeHepatectomy is a curative treatment for hepatocellular carcinoma (HCC) but deteriorating postoperative liver function can limit its benefits, especially for patients with borderline resectable (BR) HCC. We evaluated postoperative liver function trajectories and their impact on long-term survival.
methodsThe subjects of this retrospective analysis were 790 patients who underwent initial curative hepatectomy, stratified by resectability (R, BR1, BR2) and modified albumin-bilirubin (mALBI) grade. Liver function was assessed via ALBI scores pre- and postoperatively. Deterioration was defined as an ALBI score ratio < 0.9.
resultsMedian overall survival (OS) differed significantly, being 109.9, 54.4, and 40.4 months for the R, BR1, and BR2 groups, respectively (p < 0.001). While functional status at POD 90 influenced recurrence-free survival, deterioration at POD 180 was identified as a robust independent predictor of OS (HR 1.53, p = 0.005). Notably, no single preoperative or perioperative factor was a significant predictor of this long-term functional decline at POD 180. Postoperative recovery was heterogeneous, with 47.5% of patients with mALBI grade 2a improving to grade 1 by POD 180.
conclusionsPost-hepatectomy liver function at POD 180 is a key determinant of long-term survival. As this late deterioration is difficult to predict perioperatively, continuous monitoring of hepatic reserve is essential to maintain eligibility for subsequent multidisciplinary therapies.
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