AbstractBackground and AimLiver stiffness measurement using transient elastography appears to be an excellent tool for detection of liver fibrosis and cirrhosis with high accuracy. The aim of this study is to evaluate the efficacy of preoperative liver stiffness measurement in predicting post‐hepatectomy liver failure.MethodsA prospective cohort study of all consecutive patients undergoing hepatectomy for hepatocellular carcinoma from February 2010 to August 2014 was studied. All patients received detailed preoperative assessments including liver stiffness measurement. The primary outcome was post‐hepatectomy liver failure according to the International Study Group of Liver Surgery definition.ResultsA total of 255 patients were included. Liver stiffness measurement showed significant correlation with grade B or C post‐hepatectomy liver failure. (P = 0.003) Using the cutoff at 12 kPa, liver stiffness measurement had a sensitivity of 52.4% and specificity of 73.3% in predication of high‐grade (grade B or C) post‐hepatectomy liver failure. Liver stiffness measurement > 12 kPa was also an independent prognostic factor for both high‐grade post‐hepatectomy liver failure and major postoperative complications by multivariate analysis. The diagnostic accuracy was better in patients without right lobe tumor with an area under the receiver operating characteristic of 0.83 compared with an area under the receiver operating characteristic of only 0.62 in patients with right lobe tumor.ConclusionsLiver stiffness measurement using Fibroscan is good to predict high‐grade post‐hepatectomy liver failure especially in patients without right lobe tumor.