Remnant liver volume to body weight ratio > or =0.5%: A new cut-off to estimate postoperative risks after extended resection in noncirrhotic liver.
BACKGROUND
Before extended hepatectomy of five or more segments, the remnant liver volume (RLV) is usually calculated as a ratio of RLV to total liver volume (RLV-TLV) and must be >20% to 25%. This method can lead to compare parts of normal liver parenchyma to others compromised by biliary or vascular obstruction or by portal vein embolization. Extrapolating from living-donor liver transplantation, we hypothesized that RLV to body weight ratio (RLV-BWR) could accurately assess the functional limit of hepatectomy.


METHODS
From September 2000 to December 2004, volumetric measurements of RLV using computed tomography were obtained before right-extended hepatectomy in 31 patients. RLV-BWR of 0.5% as a critical point for patient course was compared with stratification by RLV-TLV (< or =25% or >25% and < or =20% or >20%).


RESULTS
Three-month morbidity and mortality were not significantly different between groups RLV-TLV < or = and >25% and between groups RLV-TLV < or = and >20%, but increased significantly in group RLV-BWR < or = 0.5% compared with group RLV-BWR > 0.5% (p = 0.038 and p = 0.019, respectively) with an non-significant increase in death from liver failure (p = 0.077).


CONCLUSIONS
RLV-BWR was more specific than RLV-TLV in predicting postoperative course after extended hepatectomy. Patients with an anticipated RLV < or = 0.5% of body weight are at considerable risk for hepatic dysfunction and postoperative mortality.
Truant
Stéphanie
S
Department of Digestive and Transplantation Surgery, University Hospital, Hospital Huriez, Lille, France.
Oberlin
Olivier
O
Sergent
Géraldine
G
Lebuffe
Gilles
G
Gambiez
Luc
L
Ernst
Olivier
O
Pruvot
François-René
FR
D000328:Adult; D000368:Aged; D001835:Body Weight; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging* / Q000601:surgery; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D011183:Postoperative Complications / Q000453:epidemiology* / Q000517:prevention & control; D011379:Prognosis; D011446:Prospective Studies; D011859:Radiography; D015996:Survival Rate