Role of quantification of hepatic steatosis and future remnant volume in predicting hepatic dysfunction and complications after liver resection for colorectal metastases: a pilot study.
OBJECTIVE
Accurate prediction of safe remnant liver volume to minimize complications following liver resection remains challenging. The aim of this study was to assess whether quantification of steatosis improved the predictive value of preoperative volumetric analysis.


METHODS
Thirty patients undergoing planned right or extended right hemi-hepatectomy for colorectal metastases were recruited prospectively. Magnetic resonance imaging was used to assess the level of hepatic steatosis and future remnant liver volume. These data were correlated with data on postoperative hepatic insufficiency, complications and hospital stay. Correlations of remnant percentage, remnant mass to patient mass and remnant mass to body surface area with and without steatosis measurements were assessed.


RESULTS
In 10 of the 30 patients the planned liver resection was altered. Moderate-severe postoperative hepatic dysfunction was seen in 17 patients. Complications arose in 14 patients. The median level of steatosis was 3.8% (range: 1.2-17.6%), but was higher in patients (n= 10) who received preoperative chemotherapy (P= 0.124), in whom the median level was 4.8% (range: 1.5-17.6%). The strongest correlation was that of remnant liver mass to patient mass (r= 0.77, P < 0.001). However, the addition of steatosis quantification did not improve this correlation (r= 0.76, P < 0.001).


CONCLUSIONS
This is the first study to combine volumetric with steatosis quantifications. No significant benefit was seen in this small pilot. However, these techniques may be useful in operative planning, particularly in patients receiving preoperative chemotherapy.
Department of Hepatobiliary Surgery, St James's University Hospital, Leeds, UK.
Alastair L
AL
Young
Dan
D
Wilson
Janice
J
Ward
John
J
Biglands
J Ashley
JA
Guthrie
K Rajendra
KR
Prasad
Giles J
GJ
Toogood
Philip J
PJ
Robinson
J Peter A
JP
Lodge
D000368:Aged; D000369:Aged, 80 and over; D017024:Chemotherapy, Adjuvant; D015179:Colorectal Neoplasms / Q000473:pathology*; D004739:England; D005234:Fatty Liver / Q000150:complications / Q000473:pathology*; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects*; D048550:Hepatic Insufficiency / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D007902:Length of Stay; D008099:Liver / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery*; D008113:Liver Neoplasms / Q000150:complications / Q000556:secondary / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D010865:Pilot Projects; D011183:Postoperative Complications / Q000209:etiology* / Q000503:physiopathology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome