Objective To explore a new cut-off of remnant liver volume-to-body weight ratio (RLV-BWR) and investigate the relationship between RLV-BWR and post-hepatectomy liver failure (PHLF) in patients with hepatocellular carcinoma (HCC) of cirrhotic liver.

Methods We analyzed the clinical data of 181 patients who underwent hemihepatectomy. Total liver volume, tumor volume, remnant liver volume and resected liver volume were measured by Myrian-Liver surgical planning system before surgery. Intraoperative resected liver volume(include resected normal liver and tumor volume) were collected by drainage method. Patients were divided into PHLF group and non-PHLF group according to the "50-50"criteria. Then the risk factors of PHLF were analyzed. The cut-off of RLV-BWR and efficiency to predict PHLF were analyzed in the subgroup of cirrhotic liver. The grading of liver cirrhosis was analysed by helical CT, retrospectively.

Results After operation, 22 patients developed PHLF and one patient died of PHLF. Logistic regression analysis showed that preoperative total bilirubin level and RLV-BWR were identified as independent predictors of PHLF. According the postoperative pathological data, 102 patients with cirrhotic liver were selected; 18 patients developed PHLF and one patient died of PHLF in the subgroup. ROC curve analysis showed that the cut-off of RLV-BWR was 0.94%(the areas under the curve was 0.853, P < 0.01, sensitivity and specialty rates were 94.4% and 72.3%) in patients with HCC in cirrhotic liver. By analyzing helical CT, 84 cases were grade Ⅰ or Ⅱ and 18 cases were grade Ⅲ.

Conclusion The risk of PHLF would increase in the HCC in cirrhotic liver patients with RLV-BWR ≤0.94% after hemihepatectomy.