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Marasco et al. Hepatoma Res 2020;6:32 Hepatoma Research
DOI: 10.20517/2394-5079.2019.54

Review Open Access

Non-invasive tests for the prediction of post-
hepatectomy liver failure in the elderly

Giovanni Marasco , Antonio Colecchia , Matteo Milandri , Benedetta Rossini , Luigina Vanessa Alemanni ,
1
2
3
1
1
Elton Dajti , Federico Ravaioli , Matteo Renzulli , Rita Golfieri , Davide Festi 1
3
1
1
3
1 Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna 40138, Italy.
2 Unit of Gastroenterology, Borgo Trento University Hospital of Verona, P.le Aristide Stefani 1, Verona 37126, Italy.
3 Radiology Unit, Sant’Orsola Malpighi Hospital, Bologna 40138, Italy.
Correspondence to: Dr. Antonio Colecchia, Unit of Gastroenterology, Borgo Trento University Hospital of Verona, P.le Aristide
Stefani 1, Verona 37126, Italy. E-mail: antonio.colecchia@aovr.veneto.it
How to cite this article: Marasco G, Colecchia A, Milandri M, Rossini B, Alemanni LV, Dajti E, Ravaioli F, Renzulli M, Golfieri R,
Festi D. Non-invasive tests for the prediction of post-hepatectomy liver failure in the elderly. Hepatoma Res 2020;6:32.
http://dx.doi.org/10.20517/2394-5079.2019.54
Received: 30 Dec 2019 First Decision: 16 Mar 2020 Revised: 5 May 2020 Accepted: 21 May 2020 Published: 18 Jun 2020
Science Editor: Bruno Nardo Copy Editor: Cai-Hong Wang Production Editor: Tian Zhang

Abstract
Post-hepatectomy liver failure (PHLF) is associated with great morbidity and mortality after resection of
hepatocellular carcinoma. Previous studies have underlined that advanced age could be a potential factor
influencing post-operative complications and long-term survival.

In the past, candidates for resection were based on the Child-Pugh classification, the predictive value of which was
rather low. The selection of patients undergoing resection in Western countries is based on the assessment of
portal hypertension (PH), which is clinically assessed by measurement of the hepatic venous pressure gradient, an
invasive and costly process. Thus, there have been several attempts to identify the best non-invasive test (NIT) to
accurately predict PHLF. Most biochemical NITs for the prediction of PHLF are focused on evaluation of underlying
liver cirrhosis and PH. Amongst them, FIB-4, which also includes the patient’s age, seems to have more robust
supporting results. In Europe and the USA., the most tested and reliable NIT for predicting PHLF is the evaluation
of liver stiffness measurement, which is also influenced by age. Imaging parameters are promising tools which
are used only in specialized centers however, and when available. Liver volume parameters, as well as contrast-
enhanced data, demonstrate good accuracy in predicting PHLF. In this scenario, the evaluation of sarcopenia and
bone mineral density through contextual imaging allows the delineation of PHLF in at-risk elderly patients. Further
studies focused on parameters for the evaluation of PHLF in elderly patients are needed.

Keywords: Post-hepatectomy liver failure, liver resection, elderly, liver stiffness measurement, indocyanine green
retention test

© The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0
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