title: Three hundred and one consecutive extended right hepatectomies: evaluation of outcome based on systematic liver volumetry.
abstract: OBJECTIVE
  This study aimed to determine the effect of preoperative liver volumetry on postoperative outcomes after extended right hepatectomy. Primary end point was to evaluate whether future liver remnant (FLR)/standardized liver volume ratio (sFLR) >20% is sufficient for a safe hepatic resection. Secondary end point was to assess whether preoperative portal vein embolization (PVE) is associated with improved outcome in patients with initial sFLR ≤ 20%.
  
  
  BACKGROUND
  An sFLR >20% of the total liver volume has been proposed as sufficient for safe hepatic resection, but this concept has not been validated in a large series. In addition, recent reports suggest preoperative PVE is indicated for sFLR <30%.
  
  
  METHODS
  The impact of sFLR and PVE on short-term outcomes (postoperative complications, liver insufficiency, and 90-day mortality) was analyzed in 301 consecutive patients after extended right hepatectomy. Liver volumetry accounted for partial resection of segment IV. Liver insufficiency was defined as peak postoperative serum bilirubin >7 mg/dL. Predictors of liver insufficiency were identified by multivariate logistic regression.
  
  
  RESULTS
  Postoperative liver insufficiency occurred in 45 patients (15%) and accounted for 61% of deaths. Among 290 patients who underwent liver volumetry, sFLR was <20% in 38 patients, 20.1% to 30% in 144, and ≥ 30% in 108. Rates of postoperative liver insufficiency and death from liver failure were similar between patients with sFLR 20.1% to 30% and sFLR ≥ 30% but higher in patients with sFLR ≤ 20% (P 0.05). Postoperative outcomes were similar between patients with increase in sFLR from ≤ 20% to >20% after PVE and patients with initial sFLR >20%. Multivariate analysis revealed that body mass index >25 kg/m2, intraoperative blood transfusion, and sFLR ≤ 20% (odds ratio = 3.18; 95% CI, 1.34-7.54) independently predicted postoperative liver insufficiency.
  
  
  CONCLUSIONS
  Systematic measurement of FLR volume is important to select patients for PVE and extended right hepatectomy. A sFLR >20% is sufficient for safe hepatic resection and sFLR 20.1% to 30% is not an indication for preoperative PVE.
authors.affiliation: Department of Surgical Oncology, Unit 444, The University of Texas MD Anderson Cancer Center, Houston, TX 77030–4009, USA.
authors.forename: Yoji
authors.initials: Y
authors.lastname: Kishi
authors.forename: Eddie K
authors.initials: EK
authors.lastname: Abdalla
authors.forename: Yun Shin
authors.initials: YS
authors.lastname: Chun
authors.forename: Daria
authors.initials: D
authors.lastname: Zorzi
authors.forename: David C
authors.initials: DC
authors.lastname: Madoff
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Wallace
authors.forename: Steven A
authors.initials: SA
authors.lastname: Curley
authors.forename: Jean-Nicolas
authors.initials: JN
authors.lastname: Vauthey
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001663:Bilirubin / Q000097:blood; D016009:Chi-Square Distribution; D002648:Child; D004621:Embolization, Therapeutic; D023381:Endpoint Determination; D005260:Female; D006498:Hepatectomy / Q000379:methods* / Q000401:mortality; D006801:Humans; D008099:Liver / Q000033:anatomy & histology* / Q000601:surgery*; D008111:Liver Function Tests; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D018579:Patient Selection; D011169:Portal Vein; D011183:Postoperative Complications / Q000401:mortality; D011300:Preoperative Care; D012189:Retrospective Studies; D012307:Risk Factors; D018709:Statistics, Nonparametric
chemical_list: D001663:Bilirubin