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Cited by 4Hepatocellular Carcinoma Treatment and PrognosisLiver physiology and pathologyOrgan Transplantation Techniques and Outcomes

The Role of Perioperative Interleukin-6 Serum Levels on Liver Dysfunction and Infectious Complications After Hepatectomy—A Systematic Review

Open access
Kofler, Alexander, Trattner, Marlene, Mairinger, Vivien, Urban, Iveta, Søreide, Kjetil, Stättner, Stefan, Primavesi, Florian·2025·Cancers
DOI 10.3390/cancers17193120PMC PMC12524086
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Abstract

Background: Interleukin-6 (IL-6) is used as a marker for infection and inflammation. After liver surgery, IL-6 is also crucial for hepatic regeneration. The value of IL-6 serum-levels to differentiate infection from imminent post-hepatectomy liver failure (PHLF) remains unclear. This review focuses on IL-6 and complications after liver resections, specifically PHLF and infections. Methods: A systematic review was performed in the PubMed, Embase, and Cochrane libraries from January 2000 to June 2025 according to PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). All English language human data publications were assessed. Results: Overall, 12 studies (n = 589 patients) evaluating perioperative serum IL-6 levels were included. Six publications reported PHLF rates, and two specifically addressed IL-6, PHLF, and infection. Several patient and surgical parameters influence IL-6 dynamics. Despite five randomized trials being published, the overall study quality was low, with a high risk of bias. In particular, IL-6 on the first postoperative day was associated with PHLF and infections, but multivariable analyses of confounding factors are lacking. A meta-analysis of studies with a specific cut-off calculation was precluded by heterogeneous cohorts and endpoints. Conclusions: IL-6 levels may have early diagnostic value regarding imminent infectious complications or PHLF early after liver resection, but the evidence is exploratory and limited by methodological weaknesses. At present, IL-6 as a single marker does not seem to show sufficient clinical discriminatory potential to differentiate between infection and impaired hepatic regeneration. Future studies should address confounding factors, ideal timepoints of assessment, different methods of serum IL-6 assays, specific cut-offs, and multi-marker combinations.

AI snapshot

Written from the paper’s full text.

TL;DR

This systematic review of 12 studies (589 patients) found that perioperative serum interleukin-6 (IL-6), especially on postoperative day 1, is associated with complications after liver resection, including post-hepatectomy liver failure (PHLF) and infection. However, heterogeneous study designs, small samples, and lack of validated cut-offs mean IL-6 remains an exploratory marker rather than routine clinical tool.

Key findings

  • In 12 included studies (n = 589; range 14–128), IL-6 measured on POD1 was most consistently associated with subsequent complications, but cut-offs varied widely by outcome.
  • Kimura et al. reported POD1 IL-6 of 401 pg/mL in patients with no infection/organ dysfunction vs 1027 pg/mL with organ dysfunction (p < 0.01) and 598 pg/mL with infectious complications (p < 0.05); a cut-off >702 pg/mL on POD1 was linked to subsequent infections with OR 3.65 (95% CI 1.47–9.07; p = 0.005).
  • Arisaka et al. found POD1 IL-6 predicted ISGLS grade B/C PHLF with AUC 0.791, cut-off 106.5 pg/mL, sensitivity 77.8%, specificity 91.5%; combining IL-6 with preoperative platelet count increased AUC to 0.838.
  • Other studies showed IL-6 differences by surgical approach and baseline liver disease: laparoscopic vs open resection had lower POD1 IL-6 (73.60 vs 116.19 pg/mL; p < 0.05 in Li et al.; 39.1 vs 98.9 pg/mL; p = 0.358 in Kasai et al.), and cirrhotic/jaundiced patients had higher 12-h postoperative IL-6 (267 and 641 pg/mL) than normal liver cases (179 pg/mL).

Methods

  • Systematic review following PRISMA, searching PubMed, Embase, and Cochrane from January 2000 to June 2025; only human studies with original data, English-language full text, and available manuscripts were included; congress abstracts were excluded.
  • The primary outcome was association of perioperative IL-6 levels with liver dysfunction, preferably by pre-defined criteria; secondary outcomes included infectious complications, overall morbidity, mortality, and potential confounders.
  • Twelve publications (all 2001–2023) were included: all prospective single-center observational cohort studies except five RCTs or secondary RCT analyses; quality was assessed with Jadad Oxford scale for RCTs and Newcastle–Ottawa scale for non-RCTs.

Limitations

  • The paper states that most studies had small sample sizes, heterogeneous cohorts and endpoints, insufficient adjustment for confounders, variable IL-6 measurement timepoints and assays, and lack of validated cut-offs; these precluded meta-analysis.
  • The paper states that all included studies were Oxford level 2b, RCT methodological quality was low (maximum 2 of 5 Jadad points except Schwarz et al. 2015 with 3), and none fulfilled all Newcastle–Ottawa features, indicating limited study quality and high risk of bias.
  • The text makes evident that the review protocol was not registered, most evidence is correlative and single-center, and studies were generally underpowered for clinically relevant PHLF given reported event rates of 5–15%.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.3390/cancers17193120

Cites

48 of 48 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

65 of 115 cited sources checked · 34 supported · 1 flagged · accuracy not yet measured

  • Findingcitation

    Longer surgeries and major hepatectomies resulted in higher IL-6 values immediately after the end of the operation.

    “Also, longer surgeries and major hepatectomies resulted in higher IL-6 values immediately after the end of the operation [22,23], while in one study, there was no apparent correlation of extend of resection with postoperative IL-6 levels [31].”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [22] Kimura, 2006, Circulating cytokines, chemokines, and stress hormones are increased in patients with organ dysfunction following liver resection, J. Surg. Res. source
    • cites [23] Strey, 2011, Early post-operative measurement of cytokine plasma levels combined with pre-operative bilirubin levels identify high-risk patients after liver resection, Int. J. Mol. Med. source
  • Premisecitation

    Serum lactate, CRP, and antithrombin III were demonstrated to identify imminent PHLF as early as within 24 h of surgery.

    “More recently, markers such as serum lactate, CRP, and antithrombin III were demonstrated to identify imminent PHLF as early as within 24 h of surgery [11,12,13].”
    Quote in the paperNot a substantial claim1 of 3 sources checked
    • cites [11] Gyoeri, 2019, The 3-60 criteria challenge established predictors of postoperative mortality and enable timely therapeutic intervention after liver resection, Hepatobiliary Surg. Nutr. source

      The Discussion reports that CRP and antithrombin III measured on postoperative day 1 predicted liver dysfunction after resection. The paper does not report serum lactate as a predictor, so it supports only part of the three-marker claim. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites [12] Fausto, 2006, Liver regeneration, Hepatology source
    • cites [13] Niederwieser, 2021, Early postoperative arterial lactate concentrations to stratify risk of post-hepatectomy liver failure, Br. J. Surg. source
  • Premisecitation

    Aside from salvage liver transplantation, no causal effective therapy exists for advanced liver dysfunction.

    “Compared to treatment options in other types of end-stage organ failure such as dialysis in kidney disease, to date, aside from salvage liver transplantation, no causal effective therapy exists for advanced liver dysfunction [8].”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [8] Sparrelid, 2020, Systematic review of MARS treatment in post-hepatectomy liver failure, HPB source

      The Discussion says there are no accepted treatment options for post-hepatectomy liver failure (PHLF) beyond supportive and liver-protective care, and identifies transplantation as a possible alternative. The Introduction likewise says no specific treatment is available for PHLF. The cited paper does not establish this broader claim for all advanced liver dysfunction. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
  • Findingcitation

    Preoperative jaundice was associated with significantly higher IL-6 levels in the first hours after resection and on POD1.

    “Preoperative jaundice was associated with significantly higher IL-6 levels in the first hours after resection [20,23] and on POD1 [22], as were intraoperative blood transfusions [22].”
    Quote in the paperNot a substantial claim1 of 3 sources checked
    • cites [20] Das, 2001, Analysis of 100 consecutive hepatectomies: Risk factors in patients with liver cirrhosis or obstructive jaundice, World J. Surg. source
    • cites [23] Strey, 2011, Early post-operative measurement of cytokine plasma levels combined with pre-operative bilirubin levels identify high-risk patients after liver resection, Int. J. Mol. Med. source

      The Results section, ‘An elevated pre-operative plasma level of bilirubin affects cytokine secretion after liver resection,’ reports significantly higher IL-6 levels 2–6 hours after resection in patients with pre-operative bilirubin above 1.0 mg/dl. It also says most patients’ bilirubin levels were within the normal range, so describing this group as having ‘preoperative jaundice’ overstates the finding. The POD1 statement is attached to citation [22], not this source. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites [22] Kimura, 2006, Circulating cytokines, chemokines, and stress hormones are increased in patients with organ dysfunction following liver resection, J. Surg. Res. source
  • Premisecitation

    Insufficient postoperative liver regeneration can be caused secondarily by infection, especially abdominal sepsis, in addition to limited future liver remnant volume.

    “Intriguingly, insufficient postoperative liver regeneration not only occurs due to primarily limited volume (small-for-size) of the future liver remnant (FLR), but can also be caused secondarily by infection, especially abdominal sepsis [5,15].”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites [5] Sparrelid, 2022, Current evidence on posthepatectomy liver failure: Comprehensive review, BJS Open source
    • cites [15] Buettner, 2021, Primary and secondary liver failure after major liver resection for perihilar cholangiocarcinoma, Surgery source

      The Results and Discussion report that abdominal sepsis was a frequent cause of secondary liver failure after major liver resection, while inadequate future liver remnant assessment was associated with primary liver failure. The paper does not establish that infection impairs postoperative liver regeneration specifically; its finding concerns liver failure, in patients undergoing resection for perihilar cholangiocarcinoma. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
  • May combine two claims. 42
  • Classified as probably not a substantial claim. 16

  • May combine two claims.

    Findingown data

    The included studies were all prospective single-center observational cohort studies, except for five partly secondary analyses of RCTs with comparably low numbers of patients and potential statistical limitations.

    “These studies (all published between 2001 and 2023) were all prospective single-center observational cohort studies, except for five (partly secondary analysis of) RCTs with comparably low numbers of patients and potential statistical limitations [24,25,26,27,28].”
    Quote in the paperNot a substantial claim3 of 5 sources checked
    • cites [24] Schwarz, C., Klaus, D.A., Tudor, B., Fleischmann, E., Wekerle, T., Roth, G., Bodingbauer, M., and Kaczirek, K. (2015). Transection Speed and Impact on Perioperative Inflammatory Response—A Randomized Controlled Trial Comparing Stapler Hepatectomy and CUSA Resection. PLoS ONE, 10. source
    • cites [25] Li, 2015, Laparoscopic surgery minimizes the release of circulating tumor cells compared to open surgery for hepatocellular carcinoma, Surg. Endosc. source
    • cites [26] Sarin, 2016, Effects of preoperative statin on liver reperfusion injury in major hepatic resection: A pilot study, Updates Surg. source
    • cites [27] Schwarz, C., Fitschek, F., Bar-Or, D., Klaus, D.A., Tudor, B., Fleischmann, E., Roth, G., Tamandl, D., Wekerle, T., and Gnant, M. (2017). Inflammatory response and oxidative stress during liver resection. PLoS ONE, 12. source

      The citation is attached to the sentence’s exception for five RCTs, but this paper identifies itself in Material and methods as a prospective observational study at the Medical University of Vienna, not an RCT or a secondary analysis of one. Its Results report 40 patients, and its Discussion acknowledges that the sample is relatively small; those details do not resolve the contrary study-design classification. (LLM, conf=0.88)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured
    • cites [28] Cata, 2017, Inflammation and pro-resolution inflammation after hepatobiliary surgery, World J. Surg. Oncol. source

  • May combine two claims.

    Findingcitation

    The methodological quality of the included RCTs was low, with a maximum of 2 points on the 5-point Jadad scale, except for Schwarz et al. 2015, which reached 3 points due to an appropriate randomization process and description of withdrawals.

    “The methodological quality of the included RCTs was low (maximum 2 points of the 5-point Jadad scale), except for the study from Schwarz et al. from 2015, which reached 3 points (intermediate quality) due to an appropriate randomization process and description of the withdrawals [24].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [24] Schwarz, C., Klaus, D.A., Tudor, B., Fleischmann, E., Wekerle, T., Roth, G., Bodingbauer, M., and Kaczirek, K. (2015). Transection Speed and Impact on Perioperative Inflammatory Response—A Randomized Controlled Trial Comparing Stapler Hepatectomy and CUSA Resection. PLoS ONE, 10. source

      Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In the regenerative context, a significant increase in TNF-alpha activates transcription factors in Kupffer cells and hepatocytes, including NF-kappaB and STAT3.

    “In this regenerative context (Figure 1B), a significant increase in tumor-necrosis factor alpha (TNF-α) activates various transcription factors in Kupffer cells and hepatocytes, including nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) and signal transducer and activator of transcription 3 (STAT3) [5].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [5] Sparrelid, 2022, Current evidence on posthepatectomy liver failure: Comprehensive review, BJS Open source

  • May combine two claims.

    Findingown data

    The review included 12 publications with a collective 589 patients, with a range of 14 to 128 patients.

    “A final number of 12 publications with a collective 589 patients (range 14–128) were included in this review (Table 1) [20,21,22,23,24,25,26,27,28,29,30,31].”
    Quote in the paperNot a substantial claim4 of 10 sources checked
    • cites [20] Das, 2001, Analysis of 100 consecutive hepatectomies: Risk factors in patients with liver cirrhosis or obstructive jaundice, World J. Surg. source
    • cites [21] Lan, 2003, Stress response to hepatectomy in patients with a healthy or a diseased liver, World J. Surg. source
    • cites [22] Kimura, 2006, Circulating cytokines, chemokines, and stress hormones are increased in patients with organ dysfunction following liver resection, J. Surg. Res. source
    • cites [23] Strey, 2011, Early post-operative measurement of cytokine plasma levels combined with pre-operative bilirubin levels identify high-risk patients after liver resection, Int. J. Mol. Med. source
    • cites [24] Schwarz, C., Klaus, D.A., Tudor, B., Fleischmann, E., Wekerle, T., Roth, G., Bodingbauer, M., and Kaczirek, K. (2015). Transection Speed and Impact on Perioperative Inflammatory Response—A Randomized Controlled Trial Comparing Stapler Hepatectomy and CUSA Resection. PLoS ONE, 10. source
    • cites [25] Li, 2015, Laparoscopic surgery minimizes the release of circulating tumor cells compared to open surgery for hepatocellular carcinoma, Surg. Endosc. source
    • cites [26] Sarin, 2016, Effects of preoperative statin on liver reperfusion injury in major hepatic resection: A pilot study, Updates Surg. source
    • cites [27] Schwarz, C., Fitschek, F., Bar-Or, D., Klaus, D.A., Tudor, B., Fleischmann, E., Roth, G., Tamandl, D., Wekerle, T., and Gnant, M. (2017). Inflammatory response and oxidative stress during liver resection. PLoS ONE, 12. source
    • cites [28] Cata, 2017, Inflammation and pro-resolution inflammation after hepatobiliary surgery, World J. Surg. Oncol. source
    • cites [29] Kasai, 2018, The inflammatory response to stress and angiogenesis in liver resection for colorectal liver metastases: A randomized controlled trial comparing open versus laparoscopic approach, Acta Chir. Belg. source

  • May combine two claims.

    Premisecitation

    Consequently, IL-6 is produced in high amounts in Kupffer cells with increased release into surrounding tissues, and hepatocytes respond by initiating growth and promoting liver regeneration.

    “Consequently, IL-6 is produced in high amounts in Kupffer cells, with a consecutive increased release into surrounding tissues. Specifically, hepatocytes then respond by initiating growth and promoting liver regeneration.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [5] Sparrelid, 2022, Current evidence on posthepatectomy liver failure: Comprehensive review, BJS Open source

      The Aetiology section states that activated Kupffer cells produce IL-6 and that IL-6 activates hepatocytes to initiate proliferation; Fig. 1 also describes IL-6 release from Kupffer cells as promoting liver regeneration. The cited passages do not establish that IL-6 is produced in high amounts or that its release into surrounding tissues increases. Page numbers were not supplied. (LLM, conf=0.84)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Among several definitions for PHLF, the International Study Group of Liver Surgery criteria are most accepted, based on bilirubin and prothrombin time outside normal ranges on postoperative day 5 or later.

    “Amongst several definitions for PHLF the International Study Group of Liver Surgery (ISGLS) criteria are most accepted (see Refs. [6,9,10]) based on bilirubin and prothrombin time outside normal ranges on postoperative day 5 or later.”
    Quote in the paperNot a substantial claim1 of 3 sources checked
    • cites [6] Rahbari, 2011, Posthepatectomy liver failure: A definition and grading by the International Study Group of Liver Surgery (ISGLS), Surgery source
    • cites [9] Balzan, 2005, The “50-50 criteria” on postoperative day 5: An accurate predictor of liver failure and death after hepatectomy, Ann. Surg. source

      The Abstract and Discussion (pages not provided) support using bilirubin and prothrombin time to assess postoperative liver failure on day 5. They describe the authors’ own 50-50 criteria—prothrombin time <50% and bilirubin >50 μmol/L—not ISGLS criteria based on values outside normal ranges on day 5 or later. The copy also does not establish that ISGLS criteria are the most accepted. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites [10] Mullen, 2007, Hepatic insufficiency and mortality in 1,059 noncirrhotic patients undergoing major hepatectomy, J. Am. Coll. Surg. source

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Post-hepatectomy liver failure remains a challenging complication in patients undergoing liver resection and represents the major cause of mortality.

    “Post-hepatectomy liver failure (PHLF) remains a challenging complication in patients undergoing liver resection and represents the major cause of mortality [5,6,7].”
    Quote in the paperSubstantial claim2 of 3 sources checked
    • cites [5] Sparrelid, 2022, Current evidence on posthepatectomy liver failure: Comprehensive review, BJS Open source
    • cites [6] Rahbari, 2011, Posthepatectomy liver failure: A definition and grading by the International Study Group of Liver Surgery (ISGLS), Surgery source
    • cites [7] Primavesi, 2023, E-AHPBA-ESSO-ESSR Innsbruck consensus guidelines for preoperative liver function assessment before hepatectomy, Br. J. Surg. source

      The Introduction describes PHLF as a frequent cause of major morbidity after extended liver resection and a major determinant of postoperative death. It does not establish that PHLF is the single major cause of mortality, as the citing sentence implies. (LLM, conf=0.86)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingcitation

    In Schwarz et al. 2015, prolonged operation time correlated with higher IL-6 levels, with a peak on POD1.

    “Prolonged operation time correlated with higher IL-6 levels, with a peak on POD1.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [24] Schwarz, C., Klaus, D.A., Tudor, B., Fleischmann, E., Wekerle, T., Roth, G., Bodingbauer, M., and Kaczirek, K. (2015). Transection Speed and Impact on Perioperative Inflammatory Response—A Randomized Controlled Trial Comparing Stapler Hepatectomy and CUSA Resection. PLoS ONE, 10. source

  • May combine two claims.

    Findingcitation

    In Ammann et al. 2023, in patients without PHLF, IL-6 declined over time, whereas it remained elevated in PHLF, resulting in a marked POD5 difference (p < 0.001) and higher perioperative AUC (p = 0.005).

    “In patients without PHLF, IL-6 declined over time, whereas it remained elevated in PHLF, resulting in a marked POD5 difference (p < 0.001) and higher perioperative AUC (p = 0.005).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [31] Ammann, M., Santol, J., Pereyra, D., Kalchbrenner, T., Wuerger, T., Laengle, J., Smoot, R.L., Hulla, W., Laengle, F., and Starlinger, P. (2023). Glucagon-like peptide-1 and glucagon-like peptide-2 regulation during human liver regeneration. Sci. Rep., 13. source

  • May combine two claims.

    Findingcitation

    In Arisaka et al. 2020, CR-PHLF had a clear association with severe morbidity (Clavien-Dindo grade >= 3) and mortality rate (33%).

    “Furthermore, CR-PHLF in this study had a clear association with severe morbidity (Clavien–Dindo grade ≥ 3) and mortality rate (33%).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [30] Arisaka, 2020, Predictive Ability of Preoperative PT-INR and Postoperative MCP1 for Post-hepatectomy Liver Failure, In Vivo source

  • May combine two claims.

    Findingcitation

    In Arisaka et al. 2020, preoperative serum IL-6 levels were comparable in CR-PHLF and no CR-PHLF groups, but postoperative levels were markedly higher in patients with liver failure on POD1, 3, and 5, with a peak on POD1.

    “While preoperative serum IL-6 levels were comparable in both groups, significant differences were noted postoperatively, with markedly higher levels in patients with liver failure on POD1, 3, and 5, with a peak on POD1.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [30] Arisaka, 2020, Predictive Ability of Preoperative PT-INR and Postoperative MCP1 for Post-hepatectomy Liver Failure, In Vivo source

      The Clinical characteristics section reports comparable preoperative inflammatory markers, significantly higher IL-6 in the liver-failure group on POD1 and POD5, and an IL-6 peak on POD1. It does not explicitly report a significant between-group IL-6 difference on POD3, so that part of the claim is not established by our copy. (LLM, conf=0.86)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Findingcitation

    In Arisaka et al. 2020, the AUC for POD1-IL-6 for CR-PHLF was 0.791 (compared to 0.929 for POD1-bilirubin), with a calculated cut-off of 106.5 pg/mL (77.8% sensitivity and 91.5% specificity).

    “The area-under-the-curve (AUC) for POD1-IL-6 for CR-PHLF was 0.791 (compared to 0.929 for POD1-Bilirubin), with a calculated cut-off of 106.5 pg/mL (77.8% sensitivity and 91.5% specificity).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [30] Arisaka, 2020, Predictive Ability of Preoperative PT-INR and Postoperative MCP1 for Post-hepatectomy Liver Failure, In Vivo source

  • May combine two claims.

    Findingcitation

    The type of parenchymal transection (CUSA vs. stapler resection) affected intraoperative portal-vein and hepatic-vein IL-6 levels, but not intraoperative or postoperative systemic IL-6 values.

    “While application of inflow-control (Pringle maneuver) did not influence IL-6 levels [23], one RCT showed that the type of parenchymal transection (cavitron ultrasonic surgical aspirator (CUSA) vs. stapler resection) did affect intraoperative portal-vein and hepatic-vein IL-6 levels, but not intraoperative or postoperative systemic IL-6 values [24].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [24] Schwarz, C., Klaus, D.A., Tudor, B., Fleischmann, E., Wekerle, T., Roth, G., Bodingbauer, M., and Kaczirek, K. (2015). Transection Speed and Impact on Perioperative Inflammatory Response—A Randomized Controlled Trial Comparing Stapler Hepatectomy and CUSA Resection. PLoS ONE, 10. source

  • May combine two claims.

    Findingcitation

    In Ammann et al. 2023, IL-6 levels rose early after both minor and major resections, but differences were driven by postoperative complications rather than resection extent.

    “Most recently, a 2023 prospective observational study by Ammann et al. (n = 46 minor and major liver resections) showed that IL-6 levels rose early after both minor and major resections, but differences were driven by postoperative complications rather than resection extent.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [31] Ammann, M., Santol, J., Pereyra, D., Kalchbrenner, T., Wuerger, T., Laengle, J., Smoot, R.L., Hulla, W., Laengle, F., and Starlinger, P. (2023). Glucagon-like peptide-1 and glucagon-like peptide-2 regulation during human liver regeneration. Sci. Rep., 13. source

      The Methods describe a prospective observational study of 46 patients undergoing minor or major liver resection. The Results report an early postoperative IL-6 increase and higher levels later in patients with post-hepatectomy liver failure (PHLF), with no disparity by resection extent after excluding PHLF and severe morbidity. The paper associates elevated IL-6 with impaired liver regeneration, but does not establish that postoperative complications generally drove the differences. (LLM, conf=0.84)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Findingcitation

    Most publications are underpowered to assess CR-PHLF with event rates of 5-15%, with commonly less than 50 patients included per study.

    “With commonly less than 50 patients included per study, most publications are underpowered to assess CR-PHLF with event rates of 5–15% according to the literature [5,7,13,38,39].”
    Quote in the paperSubstantial claim4 of 5 sources checked
    • cites [5] Sparrelid, 2022, Current evidence on posthepatectomy liver failure: Comprehensive review, BJS Open source

      The Epidemiology passage (page unavailable) reports PHLF incidence of 9–20% in some cohorts and under 5% in another, but does not give a 5–15% rate for clinically relevant PHLF. Searches for statistical power, event rates, and studies with fewer than 50 patients found no passage supporting the claim that most publications are underpowered. (LLM, conf=0.76)

      Experimental — accuracy not yet measured
    • cites [7] Primavesi, 2023, E-AHPBA-ESSO-ESSR Innsbruck consensus guidelines for preoperative liver function assessment before hepatectomy, Br. J. Surg. source

      The Patient selection section reports a PHLF incidence of 8–12%, which falls within the claimed 5–15% range, but does not specify clinically relevant PHLF. The Discussion says most retrieved publications had low-to-medium evidence; it does not say that most studies enrolled fewer than 50 patients or were underpowered to assess CR-PHLF. Page numbers were not available in our copy. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
    • cites [13] Niederwieser, 2021, Early postoperative arterial lactate concentrations to stratify risk of post-hepatectomy liver failure, Br. J. Surg. source
    • cites [38] Jotten, 2022, Impact of perioperative steroid administration in patients undergoing elective liver resection: Meta-analysis, BJS Open source

      The Discussion (page not available) says statistical power for PHLF was limited because only seven of ten trials reported it, supporting the concern about power. It does not give a 5–15% CR-PHLF event rate, and Table 1 (Results; page not available) does not support the claim that studies commonly included fewer than 50 patients in total. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites [39] Collienne, 2023, EORTC 1409 GITCG/ESSO 01—A prospective colorectal liver metastasis database for borderline or initially unresectable diseases (CLIMB): Lessons learnt from real life. From paradigm to unmet need, Eur. J. Surg. Oncol. source

      The Discussion (page unavailable) says this registry’s subgroup comparisons had wide confidence intervals because of low numbers, and the Results report post-hepatectomy liver-failure rates. It does not establish that most publications are underpowered, commonly include fewer than 50 patients per study, or have CR-PHLF event rates of 5–15%. (LLM, conf=0.76)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Ammann et al. demonstrated that IL-6 levels rise immediately after surgery in both minor and major resections but only decline in patients with adequate liver regeneration.

    “Aiming for a more granular and dynamic liver regeneration marker assessment over several days, Ammann et al. demonstrated that IL-6 levels rise immediately after surgery in both minor and major resections but only decline in patients with adequate liver regeneration.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [31] Ammann, M., Santol, J., Pereyra, D., Kalchbrenner, T., Wuerger, T., Laengle, J., Smoot, R.L., Hulla, W., Laengle, F., and Starlinger, P. (2023). Glucagon-like peptide-1 and glucagon-like peptide-2 regulation during human liver regeneration. Sci. Rep., 13. source

  • May combine two claims.

    Premisecitation

    In PHLF, IL-6 remained persistently elevated, with a marked difference evident by POD5.

    “In PHLF, IL-6 remained persistently elevated, with a marked difference evident by POD5, underscoring its role as an early inflammatory marker of impaired recovery.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [31] Ammann, M., Santol, J., Pereyra, D., Kalchbrenner, T., Wuerger, T., Laengle, J., Smoot, R.L., Hulla, W., Laengle, F., and Starlinger, P. (2023). Glucagon-like peptide-1 and glucagon-like peptide-2 regulation during human liver regeneration. Sci. Rep., 13. source

  • May combine two claims.

    Premisecitation

    IL-6 closely paralleled the postoperative increase in glucagon-like peptide-2 (GLP-2), while GLP-1 exhibited an inverse pattern.

    “Notably, IL-6 closely paralleled the postoperative increase in glucagon-like peptide-2 (GLP-2), while GLP-1 exhibited an inverse pattern.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [31] Ammann, M., Santol, J., Pereyra, D., Kalchbrenner, T., Wuerger, T., Laengle, J., Smoot, R.L., Hulla, W., Laengle, F., and Starlinger, P. (2023). Glucagon-like peptide-1 and glucagon-like peptide-2 regulation during human liver regeneration. Sci. Rep., 13. source

  • May combine two claims.

    Premisecitation

    These hormone dynamics, more pronounced in PHLF, were independent of resection extent or complication severity.

    “These hormone dynamics, more pronounced in PHLF, were independent of resection extent or complication severity, indicating a connection between metabolic and regenerative capacity rather than surgical trauma.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [31] Ammann, M., Santol, J., Pereyra, D., Kalchbrenner, T., Wuerger, T., Laengle, J., Smoot, R.L., Hulla, W., Laengle, F., and Starlinger, P. (2023). Glucagon-like peptide-1 and glucagon-like peptide-2 regulation during human liver regeneration. Sci. Rep., 13. source

      The Results sections on PHLF and postoperative morbidity report more pronounced GLP changes in PHLF and no significant differences in GLP trajectories by severe morbidity after PHLF patients were excluded. The resection-extent analysis likewise found an early GLP-2 increase after both minor and major resections, but excluded patients with PHLF or severe morbidity and found that GLP-2 remained elevated longer after major resections. Thus, the unqualified claim that the dynamics were independent of resection extent or complication severity overstates the findings. (LLM, conf=0.85)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    The search was performed in accordance with PRISMA guidelines using the PubMed, Embase, and Cochrane databases.

    “The search was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines, using the PubMed, Embase, and Cochrane databases [17].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [17] Moher, D., Liberati, A., Tetzlaff, J., Altman, D.G., and The, P.G. (2009). Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med., 6. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The heterogeneity of study designs and glucocorticoid doses applied with moderate overall evidence still result in a weak grade of recommendation in the most recent ERAS® guidelines.

    “To date, the heterogeneity of study designs and glucocorticoid doses applied with moderate overall evidence still result in a weak grade of recommendation in the most recent ERAS® (enhanced recovery after surgery) guidelines [44].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [44] Joliat, 2023, Guidelines for Perioperative Care for Liver Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations 2022, World J. Surg. source

      The Results section on preoperative steroids reports varied doses and assigns the recommendation moderate evidence and a weak grade. The quality-assessment section says inconsistency can affect evidence grading, but the paper does not specifically say that heterogeneity of study designs and doses caused the weak recommendation. No page numbers were available in our copy. (LLM, conf=0.82)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Pooled analysis of IL-6 levels showed significantly decreased levels in the glucocorticoid administration cohorts, with a mean difference of −53 pg/mL on POD1 and −22 pg/mL on POD3 (both p < 0.001).

    “Pooled analysis of IL-6 levels showed significantly decreased levels in the glucocorticoid administration cohorts, with a mean difference of −53 pg/mL on POD1 and −22 pg/mL on POD3 (both p < 0.001).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [42] Yan, 2023, Short-term outcomes of perioperative glucocorticoid administration in patients undergoing liver surgery: A systematic review and meta-analysis of randomised controlled trials, BMJ Open source

      The Results section, under “Secondary outcomes: laboratory evaluations” (page not available), reports pooled IL-6 mean differences of −53.05 on POD 1 and −21.89 on POD 3, both with p<0.0001. These support the rounded estimates and significance in the claim, but our copy does not specify that the differences are measured in pg/mL. (LLM, conf=0.85)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    IL-6 is involved in thrombopoietin homeostasis and platelet count restoration pathways as well as angiotensinogen gene expression during liver regeneration.

    “It is involved in thrombopoietin homeostasis and platelet count restoration pathways as well as angiotensinogen gene expression during liver regeneration [36,37].”
    Quote in the paperNot a substantial claim2 of 2 sources checked
    • cites [36] Reusswig, 2021, Efficiently Restored Thrombopoietin Production by Ashwell-Morell Receptor and IL-6R Induced Janus Kinase 2/Signal Transducer and Activator of Transcription Signaling Early After Partial Hepatectomy, Hepatology source

      The Discussion and Abstract Conclusions link IL-6R signaling to thrombopoietin homeostasis and platelet-count regulation after partial hepatectomy in mice. The paper does not address angiotensinogen gene expression; a search for “angiotensinogen” found no matching passage. The Results also report that recombinant hyper-IL-6 did not itself increase platelet counts. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites [37] Lai, H.S., Lin, W.H., Lai, S.L., Lin, H.Y., Hsu, W.M., Chou, C.H., and Lee, P.H. (2013). Interleukin-6 mediates angiotensinogen gene expression during liver regeneration. PLoS ONE, 8. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Comparable patterns of IL-6 dynamics beside further cytokines have recently been reported in other contexts.

    “Comparable patterns of IL-6 dynamics beside further cytokines have recently been reported in other contexts [45,46,47].”
    Quote in the paperNot a substantial claim1 of 3 sources checked
    • cites [45] Ng, 2024, Indications of pro-inflammatory cytokines in laparoscopic and open liver resection for early-stage hepatocellular carcinoma, Hepatobiliary Pancreat. Dis. Int. source
    • cites [46] Pecqueux, 2023, Interleukin-8 is superior to CRP for the prediction of severe complications in a prospective cohort of patients undergoing major liver resection, Langenbecks Arch. Surg. source
    • cites [47] Gregersen, 2023, Major open abdominal surgery is associated with increased levels of endothelial damage and interleukin-6, Microvasc. Res. source

  • May combine two claims.

    Findingreasoning

    None of the included studies fulfilled all features of the Newcastle-Ottawa scale, indicating limited study quality and a high risk of bias.

    “None of the studies fulfilled all features of the Newcastle–Ottawa scale, indicating a limited study quality and a high risk of bias.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Most included studies used commercially available ELISA kits of different manufacturers, while some used other methods such as cytometric bead arrays or (electro)chemiluminescence enzyme immunoassays.

    “Most studies used commercially available ELISA (enzyme-linked immunosorbent essay) kits of different manufacturers. However, some authors reported the use of other methods such as cytometric bead arrays or (electro)chemiluminescence enzyme immunoassays.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingreasoning

    The limited quality and high risk of bias were mainly due to inappropriate assessment of whether factors of interest were present preoperatively, inadequate demonstration of true comparability of control groups, lack of adjustment for potential confounding factors, or insufficient adequacy of follow-up.

    “This was mainly due to inappropriate assessment of whether the factors of interest were present preoperatively, inadequate demonstration of true comparability of the control groups, lack of adjustment for potential confounding factors, or insufficient adequacy of follow-up.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    In patients undergoing liver resection for hepatocellular carcinoma due to chronic hepatitis B compared with healthy donors for living liver transplantation, IL-6 rose significantly on POD1 in both groups, with a lower increase in the healthy donor group.

    “Postoperative laboratory results showed a significant rise in IL-6 levels on POD1 in both groups, with a lower increase in the healthy donor group (IL-6 preop/POD1/POD2: 4.12/47.51/25.81 pg/mL) compared to HCC patients (11.50/141.90/109.50; all p < 0.05).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [21] Lan, 2003, Stress response to hepatectomy in patients with a healthy or a diseased liver, World J. Surg. source

  • May combine two claims.

    Findingcitation

    In Kimura et al. 2006, POD1 IL-6 levels were 401 pg/mL in patients with no infections or organ dysfunction versus 1027 pg/mL in those with organ dysfunction (p < 0.01) and 598 pg/mL with infectious complications (p < 0.05).

    “Particularly, POD1 IL-6 levels were 401 pg/mL in patients with no infections/organ dysfunction versus 1027 pg/mL in those with organ dysfunction (p < 0.01) and 598pg/mL with infectious complications (p < 0.05).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [22] Kimura, 2006, Circulating cytokines, chemokines, and stress hormones are increased in patients with organ dysfunction following liver resection, J. Surg. Res. source

  • May combine two claims.

    Findingnone given

    The majority of studies utilized heterogeneous cohorts, assessed different outcome parameters with varying study endpoints and limited follow up periods, and did not apply established PHLF criteria.

    “The majority of studies furthermore utilized heterogeneous cohorts, assessed different outcome parameters with varying study endpoints and limited follow up periods, and did not apply established PHLF criteria.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    Especially on the first postoperative day, IL-6 is significantly associated with subsequent complications, but cut-offs are not well-defined.

    “Especially on the first postoperative day, IL-6 is significantly associated with subsequent complications, but cut-offs are not well-defined.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingnone given

    The included studies had heterogeneous cohorts and clinical endpoints and insufficient consideration of confounding factors.

    “Heterogeneous cohorts and clinical endpoints, as well as insufficient consideration of confounding factors, warrant adequately powered, well-designed future studies.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingnone given

    A number of studies included in this review suggest that IL-6 levels are influenced by several perioperative factors, including the surgical approach (open versus minimally invasive), the extent/volume of resection, occurrence of ischemia and reperfusion injury, intraoperative blood loss, and the baseline hepatic function.

    “A number of studies included in this review suggest that IL-6 levels are influenced by several perioperative factors, including the surgical approach (open versus minimally invasive), the extent/volume of resection, occurrence of ischemia and reperfusion injury, intraoperative blood loss, and the baseline hepatic function.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingreasoning

    At several perioperative timepoints, IL-6 values are linked to overall morbidity, PHLF, and infection-related complications.

    “At several perioperative timepoints, IL-6 values are linked to overall morbidity, PHLF, and infection-related complications, although an independent link has not yet been demonstrated and validated cut-offs are missing.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingnone given

    An independent link between IL-6 and complications has not yet been demonstrated and validated cut-offs are missing.

    “although an independent link has not yet been demonstrated and validated cut-offs are missing.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingnone given

    Current evidence is limited by small sample sizes, heterogeneous cohorts, and lack of validated cut-offs.

    “However, current evidence is limited by small sample sizes, heterogeneous cohorts, and lack of validated cut-offs.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingreasoning

    Perioperative interleukin-6 levels are consistently associated with postoperative complications after liver resection, with values on the first postoperative day showing the greatest predictive potential.

    “Perioperative interleukin-6 levels are consistently associated with postoperative complications after liver resection, with values on the first postoperative day showing the greatest predictive potential.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingnone given

    The existing clinical evidence is almost entirely correlative, with perioperative IL-6 levels measured in serum but rarely linked to mechanistic tissue-level validation.

    “The existing clinical evidence is almost entirely correlative, with perioperative IL-6 levels measured in serum but rarely linked to mechanistic tissue-level validation.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    As a pro-inflammatory cytokine, IL-6 is produced at local tissue sites by various cells.

    “As a pro-inflammatory cytokine IL-6 is produced at local tissue sites by various cells [1,2].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [1] Kishimoto, 2010, IL-6: From its discovery to clinical applications, Int. Immunol. source
    • cites [2] 2016, IL-6 pathway in the liver: From physiopathology to therapy, J. Hepatol. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    IL-6 is a major factor in hepatic regeneration.

    “Moreover, IL-6 is a major factor in hepatic regeneration [2].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [2] 2016, IL-6 pathway in the liver: From physiopathology to therapy, J. Hepatol. source

  • May combine two claims.

    Premisecitation

    Interleukin-6 plays an important role in both the acute-phase response against infections and liver regeneration.

    “Interleukin-6 (IL-6) plays an important role in both the acute-phase response against infections as well as liver regeneration (Figure 1).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [1] Kishimoto, 2010, IL-6: From its discovery to clinical applications, Int. Immunol. source
    • cites [2] 2016, IL-6 pathway in the liver: From physiopathology to therapy, J. Hepatol. source
    • cites [3] Zhang, 1996, STAT3 participates in transcriptional activation of the C-reactive protein gene by interleukin-6, J. Biol. Chem. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Under inflammatory conditions, IL-6 induces acute phase protein transcription pathways in the liver.

    “Under inflammatory conditions, IL-6 induces acute phase protein transcription pathways (C-reactive Protein/CRP, fibrinogen, etc.) in the liver (Figure 1A) [3].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [3] Zhang, 1996, STAT3 participates in transcriptional activation of the C-reactive protein gene by interleukin-6, J. Biol. Chem. source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The acute phase response in the liver usually does not exceed 48 h, after which the organism returns to normal hepatic function, except in chronic states of inflammation.

    “The acute phase response in the liver usually does not exceed 48 h, after which the organism returns to normal hepatic function, except in chronic states of inflammation [2].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [2] 2016, IL-6 pathway in the liver: From physiopathology to therapy, J. Hepatol. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The protocol for this systematic review has not been registered.

    “The protocol for the study has not been registered.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationcitation

    Perioperative steroid administration can attenuate excessive inflammatory responses, inhibit hepatic ischemia and reperfusion injury, and might potentially decrease the rate of PHLF.

    “These results underline that perioperative steroid administration can attenuate excessive inflammatory responses, inhibit hepatic ischemia and reperfusion injury, and might potentially decrease the rate of PHLF.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    Differences in study design, small sample sizes, and lack of validated cut-offs currently limit routine clinical use of IL-6.

    “However, differences in study design, small sample sizes, and lack of validated cut-offs currently limit its routine clinical use.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    Heterogeneity in sample timepoints, together with variable IL-6 assay tools used, complicates direct comparison and may contribute to inconsistent findings.

    “This heterogeneity in sample timepoints, together with variable IL-6 assay tools used, complicates direct comparison and may contribute to inconsistent findings.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Abstracts were screened and double-checked by two investigators to identify relevant studies.

    “Abstracts were screened and double-checked by two investigators to identify relevant studies.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Overproduction of IL-6 potentially indicates an overwhelming systemic inflammatory response syndrome (SIRS), resulting in organ failure, an impaired immune system, and consecutive severe infections.

    “Overproduction of IL-6 potentially indicates an overwhelming systemic inflammatory response syndrome (SIRS), resulting in organ failure, an impaired immune system, and consecutive severe infections [22].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [22] Kimura, 2006, Circulating cytokines, chemokines, and stress hormones are increased in patients with organ dysfunction following liver resection, J. Surg. Res. source

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductcitation

    Randomized-controlled trials were assessed and graded for methodological quality according to the Jadad Oxford scale, and non-RCT studies according to the Newcastle-Ottawa scale.

    “All randomized-controlled trials (RCTs) were assessed and graded for methodological quality according the Jadad Oxford scale [18], and all non-RCT studies according the Newcastle–Ottawa scale [19].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [18] Jadad, 1996, Assessing the quality of reports of randomized clinical trials: Is blinding necessary?, Control. Clin. Trials source
    • cites [19] Stang, 2010, Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses, Eur. J. Epidemiol. source

  • Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

    Interpretationreasoning

    Overall, evidence remains exploratory, and conclusions should be interpreted with caution due to small sample sizes and risk of bias and be considered hypothesis-generating rather than definitive.

    “Overall, evidence remains exploratory, and conclusions should be interpreted with caution due to small sample sizes and risk of bias and be considered hypothesis-generating rather than definitive.”
    Quote in the paperNot a substantial claim
51 of 51

  • The paper relies on this without support.

    Reliable early markers to identify patients at risk for post-hepatectomy liver failure and infectious complications remain limited.

    “Reliable early markers to identify patients at risk remain limited.”
1 of 1

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • The RCT list omits a study later called an RCT

    Minor

    The stated list of five RCTs excludes study [29], which the review later identifies as an RCT.

  • The RCT list includes a study later called a cohort study

    Minor

    The study cited as [27] is included among the five RCTs, but is later described as a cohort study.

2 of 2

Cites

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Authors
Kofler, A., Trattner, M., Mairinger, V., Urban, I., Søreide, K., Stättner, S., & Primavesi, F.
Affiliations
  • Innsbruck Medical University (AT)
  • Salzburger Landeskliniken (AT)
  • Department of Surgery, Ordensklinikum Linz, 4010 Linz, Austria
  • Stavanger University Hospital (NO)
  • Johannes Kepler University of Linz (AT)
Corresponding author
Primavesi, Florian
ORCID
Venue
Cancers
Publisher
MDPI AG
Published
2025-09-25
Volume
17
Issue
19
Pages
3120
ISSN
2072-6694 (ISSN-L)
DOI
10.3390/cancers17193120
PMC
PMC12524086
OpenAlex
W4414518145
Semantic Scholar
1eacd0d166865e0e86476db19ec024200870c0fc
Cited by
4
References
48
Citations by year
2026: 3 · 2025: 1
FWCI
0.98
Type
journal article
Language
en
Open access
Licence
Locations
  • Cancers (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (submittedVersion, cc-by)
Topics
  • Health Sciences › Medicine › Hepatology › Hepatocellular Carcinoma Treatment and Prognosis
  • Health Sciences › Medicine › Hepatology › Liver physiology and pathology
  • Health Sciences › Medicine › Surgery › Organ Transplantation Techniques and Outcomes
Keywords
interleukin-6, hepatectomy, post-hepatectomy liver failure, postoperative infection, liver regeneration, inflammatory markers, diagnostic thresholds

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-23.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-23.

Cited sources are checked by gpt-6-sol.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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