{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T01:52:09Z","timestamp":1783475529700,"version":"3.55.0"},"reference-count":31,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T00:00:00Z","timestamp":1762819200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T00:00:00Z","timestamp":1762819200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100001691","name":"Japan Society for the Promotion of Science","doi-asserted-by":"publisher","award":["JP23K08127"],"award-info":[{"award-number":["JP23K08127"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Hepato Biliary Pancreat"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background\/Purpose<\/jats:title>\n                    <jats:p>Major hepatopancreatoduodenectomy (HPD) is associated with a high risk of postoperative mortality, often due to pancreatic fistula formation and liver failure. We evaluated the impact of the functional reserve of the remnant liver on postoperative pancreatic fistula (POPF) formation and mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Patients who underwent resection of \u2265\u20093 hepatic segments with pancreatoduodenectomy were retrospectively analyzed. The association of the future liver remnant\u2010to\u2010body weight ratio (FLR\/BW) with POPF formation and mortality was assessed. With receiver operating characteristic (ROC) curve analysis, the optimal cutoff values were determined. Underlying pancreatic conditions were also examined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>POPFs occurred in 64% of 177 patients. The predictors of POPFs included a high BMI, low pancreatic CT attenuation, and small pancreatic duct diameter. The FLR\/BW was not associated with POPF formation. Postoperative mortality occurred in 6% of patients, mostly due to Grade C postpancreatectomy hemorrhage. An FLR\/BW &lt;\u20090.8% was an independent predictor of mortality (OR 15.79); patients with a ratio below 0.8% had a 14% mortality rate.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Poor remnant liver functional reserve is not associated with POPF formation but significantly increases mortality after major HPD. Ensuring sufficient liver reserve, perhaps through more proactive use of portal vein embolization or parenchyma\u2010sparing procedures, may improve outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jhbp.70026","type":"journal-article","created":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T10:20:27Z","timestamp":1762856427000},"page":"94-103","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Influence of the Functional Reserve of the Remnant Liver on Major Hepatectomy Combined With Pancreatoduodenectomy"],"prefix":"10.1002","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8802-1188","authenticated-orcid":false,"given":"Takashi","family":"Mizuno","sequence":"first","affiliation":[{"name":"Division of Surgical Oncology, Department of Surgery Nagoya University Graduate School of Medicine  Nagoya 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