Assessment of Resected Liver Fibrosis Stages by Preoperative/Intraoperative Needle Biopsy among Hepatocellular Carcinoma Patients

Purpose: Posthepatectomy liver failure (PHLF) is a major complication of hepatectomy. Although the extent of liver resection and fibrosis stages were previously identified as predictors of the development of PHLF, fibrosis stages were diagnosed using samples from resected livers. We evaluated the association between preoperative/intraoperative liver biopsies and final fibrosis stages.Methods: We included 272 patients who underwent an initial hepatectomy at our facility between January 2014 and December 2018.Results: PHLF occurred in 70 patients (25.7%) and decreased their overall survival (p = 0.0001). Preoperative/intraoperative liver biopsies showed a significant correlation with final fibrosis stages (p < 0.0001). The underestimation rates of preoperative and intraoperative F0/F1/F2 were 16.9% and 28.2%, respectively. Among the preoperative factors, 99mTc-GSA scintigraphy LHL < 0.91 was significantly associated with the resected liver fibrosis stages (hazard ratio [HR], 2.38; 95% confidence interval [CI]: 1.37–4.21; p = 0.0022). The underestimation rates of preoperative F0/F1/F2 with 99mTc-GSA scintigraphy LHL > 0.91 and Conclusions: The fibrosis stages of the resected livers were associated with preoperative and intraoperative liver biopsies. Successful hepatectomies could be performed in accordance with findings from preoperative liver biopsies, 99mTc-GSA scintigraphy, and intraoperative liver biopsies without the incidence of PHLF.