Liver regeneration at day 7 after right hepatectomy: global and segmental volumetric analysis by using CT.
OBJECTIVE
To evaluate total and segmental liver regeneration by comparing preoperative computed tomographic (CT) volumetry and CT volumetry on postoperative day 7 following right hepatectomy and to study liver regeneration estimated by using CT volumetry in patients with different surgical indications and in whom the middle hepatic vein (MHV) was harvested or not harvested.


METHODS
Local medical ethics committee and state medical board approval and informed consent were obtained. Twenty-seven patients who had undergone right hepatectomy were imaged with multidetector CT preoperatively and at day 7 postoperatively. Fourteen patients (group 1) were living liver donors, including eight in whom the MHV was harvested. Thirteen patients (group 2) underwent right hepatectomy for other indications. Volumetric measurements were performed semiautomatically. Total volumes and segmental volumes were measured for total liver, future liver remnant (FLR), and liver remnant. Total and segmental early regeneration index, defined as [(V(LR) - V(FLR))/V(FLR)] x 100, where V(LR) is volume of the liver remnant and V(FLR) is volume of the FLR, were calculated. Comparisons were performed by using the Mann-Whitney test, and a P value of less than .05 was considered significant.


RESULTS
The liver remnant at day 7 showed a 64% increase in volume from the FLR, without a significant difference between groups 1 and 2. In the group with harvesting of MHV, volume and segmental regeneration index were significantly lower than in other patients, for both the caudate lobe (32 and 48 mL, respectively; P = .049) and liver segment IV (Couinaud) (206 and 334 mL, respectively; P = .008).


CONCLUSIONS
Segmental regeneration of the liver following right hepatectomy varies, depending on whether the MHV was harvested, and seems to be related to hepatic outflow.
Zappa
Magaly
M
Department of Radiology, Hôpital Beaujon, 100 boulevard du Général Leclerc, 92110 Clichy, France. magaly.zappa@bjn.aphp.fr
Dondero
Federica
F
Sibert
Annie
A
Vullierme
Marie-Pierre
MP
Belghiti
Jacques
J
Vilgrain
Valerie
V
D000328:Adult; D000368:Aged; D005260:Female; D006498:Hepatectomy; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008099:Liver / Q000000981:diagnostic imaging / Q000254:growth & development / Q000601:surgery; D008115:Liver Regeneration; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome