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Spleen volumetry and liver transient elastography: Predictors of persistent posthepatectomy decompensation in patients with hepatocellular carcinoma

  • Ramiro Fernández-Placencia
    Affiliations
    Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris (APHP), Centre Hépato-Biliaire, Villejuif, France

    Department of Abdominal Surgery, Hepato-Pancreato-Biliary Section, Instituto Nacional de Enfermedades Neoplásicas (INEN) Lima, Peru
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  • Nicolas Golse
    Affiliations
    Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris (APHP), Centre Hépato-Biliaire, Villejuif, France

    Département Hospitalo-Universitaire Hepatinov, Villejuif, France

    INSERM, Unit 1193, Villejuif, France

    Univ Paris-Sud, UMR-S 1193, Villejuif, France
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  • Luis Cano
    Affiliations
    INSERM, Unit 991, Univ Rennes, Centre Hospitalier Universitaire Rennes, INRA, Univ Bretagne Loire, Nutrition Metabolism and Cancer, Rennes, France
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  • Marc-Antoine Allard
    Affiliations
    Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris (APHP), Centre Hépato-Biliaire, Villejuif, France

    Département Hospitalo-Universitaire Hepatinov, Villejuif, France

    INSERM, Unit 1193, Villejuif, France
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  • Gabriella Pittau
    Affiliations
    Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris (APHP), Centre Hépato-Biliaire, Villejuif, France
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  • Oriana Ciacio
    Affiliations
    Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris (APHP), Centre Hépato-Biliaire, Villejuif, France
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  • Antonio Sa Cunha
    Affiliations
    Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris (APHP), Centre Hépato-Biliaire, Villejuif, France

    Département Hospitalo-Universitaire Hepatinov, Villejuif, France

    INSERM, Unit 1193, Villejuif, France
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  • Denis Castaing
    Affiliations
    Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris (APHP), Centre Hépato-Biliaire, Villejuif, France

    Département Hospitalo-Universitaire Hepatinov, Villejuif, France

    INSERM, Unit 1193, Villejuif, France
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  • Chady Salloum
    Affiliations
    Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris (APHP), Centre Hépato-Biliaire, Villejuif, France
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  • Daniel Azoulay
    Affiliations
    Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris (APHP), Centre Hépato-Biliaire, Villejuif, France

    Department of Hepatobiliary and Pancreatic Surgery and Transplantation, Sheba Medical Center, Faculty of Medicine Tel Aviv University, Israel
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  • Daniel Cherqui
    Affiliations
    Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris (APHP), Centre Hépato-Biliaire, Villejuif, France

    Département Hospitalo-Universitaire Hepatinov, Villejuif, France

    INSERM, Unit 1193, Villejuif, France
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  • Didier Samuel
    Affiliations
    Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris (APHP), Centre Hépato-Biliaire, Villejuif, France

    Département Hospitalo-Universitaire Hepatinov, Villejuif, France

    INSERM, Unit 1193, Villejuif, France

    Univ Paris-Sud, UMR-S 1193, Villejuif, France
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  • René Adam
    Affiliations
    Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris (APHP), Centre Hépato-Biliaire, Villejuif, France

    Département Hospitalo-Universitaire Hepatinov, Villejuif, France

    INSERM, Unit 985, Villejuif, France

    Univ Paris-Sud, UMR-S 985, Villejuif, France
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  • Eric Vibert
    Correspondence
    Reprint requests: Prof. Eric Vibert, 12 Avenue Paul Vaillant Couturier, 94804 Villejuif Cedex, France.
    Affiliations
    Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris (APHP), Centre Hépato-Biliaire, Villejuif, France

    Département Hospitalo-Universitaire Hepatinov, Villejuif, France

    INSERM, Unit 1193, Villejuif, France

    Univ Paris-Sud, UMR-S 1193, Villejuif, France
    Search for articles by this author
Published:March 20, 2020DOI:https://doi.org/10.1016/j.surg.2020.02.009

      Abstract

      Background

      Posthepatectomy decompensation remains a frequent and poor outcome after hepatectomy, but its prediction is still inaccurate. Liver stiffness measurement can predict posthepatectomy decompensation, but there is a so-called “gray zone” that requires another predictor. Because splenomegaly is an objective sign of portal hypertension, we hypothesized that spleen volumetry could improve the identification of patients at risk.

      Methods

      Patients with hepatocellular carcinoma who underwent hepatectomy in our tertiary center between August 2014 and December 2017 were reviewed. The primary endpoint was to determine if the spleen volumetry and liver stiffness measurement were independent predictors of posthepatectomy decompensation, and secondarily, to determine if they were synergistic through a theoretic predictive model.

      Results

      One hundred and seven patients were included. The median follow-up time was 3 months (3–5). Postoperative 90-day mortality was 4.7%. By multivariate analysis, liver stiffness measurement and spleen volumetry predicted posthepatectomy decompensation. The liver stiffness measurement had a cutoff point of 11.6 kPa (area under receiver operating curve = 0.71 confidence interval 95% 0.71–0.88, sensitivity: 89%, specificity: 47%). The spleen volumetry cutoff point was 381.1 cm3 (area under receiver operating curve = 0.78, 95% confidence interval 0.77–0.93, sensitivity: 55%, specificity: 91%). The spleen volumetry improved prediction of posthepatectomy decompensation, because use of the spleen volumetry increased sensitivity (from 62% to 97%) and the negative predictive value (from 96% to 100%) along with a negligible decrease in specificity (from 96.7 to 93.4) and positive predictive value (from 64% to 59%) (P = .003).

      Conclusion

      Spleen volumetry (>380 cm3) and liver stiffness measurement (>12 kPa) are non-invasive, independent, and synergistic tools that appear to be able to predict posthepatectomy decompensation. The importance of this finding is that these measurements may help to anticipate posthepatectomy decompensation and may possibly be used to direct alternative treatments to resection.
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