Relevance of liver surface nodularity for preoperative risk assessment in patients with resectable hepatocellular carcinoma.

Background Quantification of liver surface nodularity (LSN) on routine preoperative CT images allows detection of cirrhosis and clinically significant portal hypertension. This study aimed to assess the relevance of LSN in preoperative assessment of operative risks for patients with resectable hepatocellular carcinoma (HCC). Methods All patients undergoing hepatectomy for HCC between 2012 and 2017 were analysed retrospectively. LSN was assessed at the liver-fat interface on the left liver lobe on preoperative CT images. The feasibility of LSN quantification was assessed. The association between LSN and outcomes (severe complications and posthepatectomy liver failure (PHLF)) was evaluated by multivariable analysis and after propensity score matching. Results Among 210 patients, LSN measurement was successful in 187 (89 center dot 0 per cent). Among these, the median LSN score was 2 center dot 42 (i.q.r. 2 center dot 21-2 center dot 66) and 52 center dot 9 per cent had severe fibrosis, including 33 center dot 7 per cent with cirrhosis. LSN score increased with hepatic venous pressure gradient (P = 0 center dot 048), severity of steatosis (P = 0 center dot 011) and fibrosis grade (P = 0 center dot 001). LSN score was independently associated with severe complications (odds ratio (OR) 5 center dot 25; P = 0 center dot 006) and PHLF (OR 6 center dot 78; P = 0 center dot 003). After matching with respect to model for end-stage liver disease, aspartate aminotransferase-to-platelet ratio index and fibrosis-4 score, patients with a LSN score of 2 center dot 63 or higher retained an increased risk of PHLF (OR 5 center dot 81; P = 0 center dot 018). In the subgroup of patients without severe fibrosis, LSN was accurate in predicting severe complications (P = 0 center dot 005). Patients with (P = 0 center dot 039) or without (P = 0 center dot 018) severe fibrosis with increased LSN score had a higher comprehensive complication index score. Among patients with cirrhosis who had clinically significant portal hypertension, a LSN value below 2 center dot 63 ruled out the risk of PHLF. Conclusion LSN measurement represents a practical tool that may allow improvement in the preoperative evaluation and management of patients with HCC.