佐久間 康成

BACKGROUND/AIM: The Albumin-Bilirubin (ALBI) score was initially developed to estimate prognosis in patients with hepatocellular carcinoma. Recently, its prognostic relevance has been extended to intrahepatic cholangiocarcinoma; however, its impact on perihilar cholangiocarcinoma remains unclear. PATIENTS AND METHODS: A total of 71 patients who underwent hepatectomy for perihilar cholangiocarcinoma between 2007 and 2024 at Jichi Medical University were retrospectively analyzed. Preoperative blood samples were obtained within two weeks before surgery, after effective jaundice control. Survival outcomes were evaluated using the Kaplan-Meier method and compared with the log-rank test. Cox proportional hazards modeling was used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for overall survival. RESULTS: Patients with ALBI Grade 1 had a significantly longer median survival time compared to those with ALBI Grade 2 or 3 (not reached vs. 45 months vs. 13 months, respectively; p=0.001). The prognostic nutritional index (PNI) was significantly lower in ALBI Grade 2/3 than in Grade 1 (41.6±5.7 vs. 49.5±5.9, p<0.001). Similarly, carbohydrate antigen 19-9 (CA19-9) levels were higher in ALBI Grade 2/3 compared to Grade 1 (493±129 vs. 98±176 U/mL, p=0.002). Multivariable analysis identified ALBI Grade 2/3 as an independent negative prognostic factor for overall survival (HR=2.14, 95% CI=1.01-4.54, p=0.047). Regression analysis showed a strong inverse correlation between ALBI score and serum albumin levels (R=-0.9624, p=0.001). CONCLUSION: ALBI score may provide valuable prognostic information for long-term outcomes in patients undergoing hepatectomy for perihilar cholangiocarcinoma.

BACKGROUND: Living donor hepatectomy carries a risk of bleeding, and allogeneic transfusion may cause adverse effects. Autologous blood preparation is therefore considered a safer strategy. While preoperative autologous donation (PAD) is widely used, acute normovolemic hemodilution (ANH) may overcome its limitations and offer a practical alternative. However, evidence supporting ANH in donor surgery remains limited. This study compared the clinical utility of ANH and PAD in living donor hepatectomy. METHODS: We retrospectively analyzed 60 consecutive cases of living donor right hepatectomy performed between 2017 and 2025. Among them, 58 donors who received either PAD or ANH were compared using 1:2 propensity score matching. Perioperative laboratory values, surgical outcomes, any allogeneic transfusion, and postoperative complications were evaluated. RESULTS: No unexpected intraoperative adverse events or allogeneic transfusions occurred. All ANH donors received autologous reinfusion, compared with only 6.5% of PAD donors. After matching, 27 donors (18 PAD, 9 ANH) were analyzed. Whole blood viscosity was higher in the ANH group. Weight-adjusted intraoperative bleeding was lower (2.6 vs. 4.6 mL/kg, p = .024; q = 0.106) and operative time was shorter (321 vs. 390 min, p = .007; q = 0.077) in the ANH group. Postoperative complication rates were comparable. Area under the curve analysis indicated better preservation of total protein (p = .038) and prothrombin time-international normalized ratio (p = .010) across the perioperative period in the ANH group. CONCLUSIONS: ANH maintained transfusion avoidance and donor safety comparable to PAD while improving operative efficiency, supporting ANH as a safe, effective alternative in living donor right hepatectomy.

BACKGROUND: Perihilar cholangiocarcinoma with large hepatic resection is associated with high risk for morbidity and mortality. To improve outcomes, assessment of remnant liver function is crucial. METHODS: A total of 70 patients with perihilar cholangiocarcinoma were examined retrospectively. Liver function was evaluated <1 month preoperatively by hepatic clearance of remnant liver using 99mTc-galactosyl serum albumin (GAS) scintigraphy and computed tomography, and clinicopathological data and outcomes were analyzed in comparison GSA scintigraphy with liver function test based on computed tomography volumetry. RESULTS: There was no postoperative 90-day mortality, with 10 patients of posthepatectomy liver failure (PHLF) Grade A, 10 of Grade B, and 1 of Grade C. Area under the curve of receiver operating curve showed better prediction power for PHLF compared to remnant liver volume/body surface area or future liver remnant/body weight, especially in patients with incomplete change of liver function. In univariable analysis, <150 ml/min ml/min cutoff of hepatic clearance of remnant liver and >1750 ml intra-operative blood loss were significant risk factors for PHLF. In multivariable analysis, <150 ml/min cutoff was a significant risk factor for PHLF. The area under the curve of hepatic clearance of remnant liver indicated better predictivity in patients with incomplete change of liver function compared with complete change of liver function. CONCLUSIONS: The hepatic clearance of remnant liver may have predictive power in patients with incomplete changes in liver function compared to computed tomography-based methods. Preoperative measurement of hepatic clearance of remnant liver may assist in risk stratification for surgical management.