Background: We developed a heatmap-based model to predict severe posthepatectomy liver failure (PHLF) by integrating the albumin-bilirubin (ALBI) score and the liver resection rate in patients with primary liver cancer.

Methods: This retrospective study included 524 patients with primary liver cancer who underwent hepatectomy at our institution between January 2002 and October 2024. The liver resection rate was calculated as: (resected liver volume — tumor volume)/total functional liver volume×100. Severe PHLF was defined as Grade B or C according to the International Study Group of Liver Surgery (ISGLS) criteria. Independent risk factors for severe PHLF were identified using multivariate analysis.

Results: Severe PHLF occurred in 56 patients. Multivariate analysis revealed that a higher ALBI score (odds ratio [OR]=8.91 per 1.0 increase) and greater liver resection rate (OR=1.05 per 1% increase) were independent predictors of severe PHLF. When applying a 50% threshold for predicted PHLF incidence, the heatmap model expanded the surgical indication to 67 additional patients (13%) compared to the Makuuchi criteria. While the positive predictive value was similar between the heatmap model and Makuuchi criteria (90.9% vs. 93.4%), the heatmap model showed a markedly higher negative predictive value (58.8% vs. 32.9%).

Conclusion: The heatmap model is a valuable tool for preoperative risk assessment and surgical decision-making based on hepatic functional reserve, potentially improving the prevention of severe PHLF.

Background: Various embolic materials and techniques are used in partial splenic embolization (PSE), with procedural approaches differing among institutions. At our hospital, the torpedo method was introduced as an alternative to the conventional fragmentation method in September 2021. However, the clinical impact of the torpedo method remains unclear.

Objective: To compare perioperative outcomes between the torpedo and fragmentation methods for PSE.

Methods: Eighteen patients who underwent PSE at our institution were retrospectively analyzed (torpedo group: 11 patients; fragmentation group: 7 patients). Operative time and perioperative laboratory parameters were compared between the groups.

Results: The torpedo method was associated with a trend toward shorter operative time compared to the fragmentation method. On postoperative day 1, there were no significant differences in peripheral white blood cell (WBC) count or serum C-reactive protein (CRP) levels between the groups. However, CRP levels on postoperative day 7 were significantly higher in the torpedo group, although no differences were observed in the incidence of fever or pain.

Discussion: The torpedo method allows for embolization at a relatively proximal location, which may contribute to reduced procedural time.

Conclusion: The torpedo method may be a useful technique for shortening operative time in PSE without increasing perioperative complications.