{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T19:18:39Z","timestamp":1790623119564,"version":"4.1.0"},"reference-count":30,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T00:00:00Z","timestamp":1786665600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T00:00:00Z","timestamp":1786665600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Annals of Gastroent Surgery"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Liver fibrosis influences tolerance to surgical stress, dictating postoperative complication risks after hepatectomy for hepatocellular carcinoma (HCC). While conventional systems assess hepatic function, they may not fully capture structural fibrosis. This study evaluated the whether preoperative Fibrosis\u20104 (FIB\u20104) index is associated with severe complications and \u201cendogenous organ failure\u201d (EOF: systemic decompensation unaccompanied by localized surgical\u2010site complications).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective study analyzed 1778 HCC patients undergoing hepatectomy between 2001 and 2020. A restricted cubic spline (RCS) model identified the optimal preoperative FIB\u20104 cutoff for predicting major complications (Clavien\u2010Dindo [C\u2010D] Grade\u2009\u2265\u2009IIIa). Following stratification by this cutoff, intergroup comparisons and multivariable logistic regression analyses were performed to identify independent predictors of major and severe (C\u2010D Grade\u2009\u2265\u2009IIIb) complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      RCS analysis suggested a FIB\u20104 threshold of 5.0 for an increased trend in complication risk. The High FIB\u20104 index group (\u2265\u20095.0,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009385) showed a higher frequency of severe complications (7.0% vs. 3.4%) and EOF (3.1% vs. 0.4%) compared to the Low FIB\u20104 index group (&lt;\u20095.0,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20091393). Among patients developing life\u2010threatening complications (C\u2010D Grade\u2009\u2265\u2009IV), 92.3% of the High FIB\u20104 index group presented with EOF. In multivariable analyses, FIB\u20104\u2009\u2265\u20095.0 was consistently and independently associated with both major and severe complications.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>A preoperative FIB\u20104\u2009\u2265\u20095.0 was associated with an increased incidence of severe complications, particularly EOF, after hepatectomy. This simple index could serve as a clinical indicator of systemic vulnerability, enhancing surgical risk stratification beyond traditional functional markers.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ags3.70263","type":"journal-article","created":{"date-parts":[[2026,8,15]],"date-time":"2026-08-15T01:42:33Z","timestamp":1786758153000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Preoperative\n                    <scp>FIB<\/scp>\n                    \u20104 Index as a Potential Factor Associated With Severe Postoperative Complications and Endogenous Organ Failure After Hepatectomy for Hepatocellular Carcinoma"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4623-1210","authenticated-orcid":false,"given":"Masanori","family":"Nakamura","sequence":"first","affiliation":[{"name":"Division of Digestive Surgery, Department of Surgery Nihon University School of Medicine  Tokyo Japan"},{"name":"Department of Gastroenterological Surgery Nagoya University Graduate School of Medicine  Nagoya Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yukiyasu","family":"Okamura","sequence":"additional","affiliation":[{"name":"Division of Digestive Surgery, Department of Surgery Nihon University School of Medicine  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Osamu","family":"Aramaki","sequence":"additional","affiliation":[{"name":"Division of Digestive Surgery, Department of Surgery Nihon University School of Medicine  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nao","family":"Yoshida","sequence":"additional","affiliation":[{"name":"Division of Digestive Surgery, Department of Surgery Nihon University School of Medicine  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yusuke","family":"Mitsuka","sequence":"additional","affiliation":[{"name":"Division of Digestive Surgery, Department of Surgery Nihon University School of Medicine  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7104-0507","authenticated-orcid":false,"given":"Hayato","family":"Abe","sequence":"additional","affiliation":[{"name":"Division of Digestive Surgery, Department of Surgery Nihon University School of Medicine  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shunsuke","family":"Yamagishi","sequence":"additional","affiliation":[{"name":"Division of Digestive Surgery, Department of Surgery Nihon University School of Medicine  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasuhiro","family":"Okumura","sequence":"additional","affiliation":[{"name":"Division of Digestive Surgery, Department of Surgery Nihon University School of Medicine  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyongsun","family":"Pak","sequence":"additional","affiliation":[{"name":"Division of Biostatistics, Department of Data Management, Center for Clinical Research National Center for Child Health and Development  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0361-8071","authenticated-orcid":false,"given":"Shinobu","family":"Masuda","sequence":"additional","affiliation":[{"name":"Division of Human Pathology, Department of Pathology and Microbiology Nihon University School of Medicine  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,14]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2024.08.028"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10147-025-02703-7"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/hpb.12069"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/bjs\/znad233"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2021.05.025"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2014.57.9151"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.21178"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1159\/000488778"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/ssu.2980090404"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(11)61347-0"},{"key":"e_1_2_12_12_1","volume-title":"The General Rules for the Clinical and Pathological Study of Primary Liver Cancer","author":"Liver Cancer Study Group of Japan","year":"2009"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1365-182X(17)30755-4"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000004808"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1159\/000018770"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000658-190810000-00005"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.sla.0000133083.54934.ae"},{"issue":"1","key":"e_1_2_12_18_1","first-page":"1","article-title":"KDIGO Clinical Practice Guideline for Acute Kidney Injury","volume":"2","author":"Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group","year":"2012","journal-title":"Kidney International. Supplement"},{"issue":"23","key":"e_1_2_12_19_1","first-page":"2526","article-title":"Acute Respiratory Distress Syndrome: The Berlin Definition","volume":"307","author":"ARDS Definition Task Force","year":"2012","journal-title":"Journal of the American Medical Association"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1477-2574.2011.00319.x"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2014.06.012"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2010.12.002"},{"key":"e_1_2_12_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajic.2008.03.002"},{"key":"e_1_2_12_24_1","first-page":"603","volume-title":"Multivariable Data Analysis","author":"Hair J. F.","year":"2021"},{"key":"e_1_2_12_25_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-319-19425-7"},{"key":"e_1_2_12_26_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2105-12-77"},{"key":"e_1_2_12_27_1","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.1040752"},{"key":"e_1_2_12_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2014.10.022"},{"key":"e_1_2_12_29_1","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000013696"},{"key":"e_1_2_12_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejso.2025.109723"},{"key":"e_1_2_12_31_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrdp.2016.41"}],"container-title":["Annals of Gastroenterological Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ags3.70263","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ags3.70263","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ags3.70263","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,15]],"date-time":"2026-08-15T01:42:34Z","timestamp":1786758154000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ags3.70263"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,14]]},"references-count":30,"alternative-id":["10.1002\/ags3.70263"],"URL":"https:\/\/doi.org\/10.1002\/ags3.70263","archive":["Portico"],"relation":{},"ISSN":["2475-0328","2475-0328"],"issn-type":[{"value":"2475-0328","type":"print"},{"value":"2475-0328","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,14]]},"assertion":[{"value":"2026-05-13","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-04","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-14","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"ags3.70263"}}