title: Kinetic growth rate after portal vein embolization predicts posthepatectomy outcomes: toward zero liver-related mortality in patients with colorectal liver metastases and small future liver remnant.
abstract: BACKGROUND
  Standardized future liver remnant (sFLR) volume and degree of hypertrophy after portal vein embolization (PVE) have been recognized as important predictors of surgical outcomes after major liver resection. However, the regeneration rate of the FLR after PVE varies among individuals and its clinical significance is unknown.
  
  
  METHODS
  Kinetic growth rate (KGR) is defined as the degree of hypertrophy at initial volume assessment divided by number of weeks elapsed after PVE. In 107 consecutive patients who underwent liver resection for colorectal liver metastases with an sFLR volume >20%, the ability of the KGR to predict overall and liver-specific postoperative morbidity and mortality was compared with sFLR volume and degree of hypertrophy.
  
  
  RESULTS
  Using receiver operating characteristic analysis, the best cutoff values for sFLR volume, degree of hypertrophy, and KGR for predicting postoperative hepatic insufficiency were estimated as 29.6%, 7.5%, and 2.0% per week, respectively. Among these, KGR was the most accurate predictor (area under the curve 0.830 [95% CI, 0.736-0.923]; asymptotic significance, 0.002). A KGR of <2% per week vs ≥2% per week correlates with rates of hepatic insufficiency (21.6% vs 0%; p = 0.0001) and liver-related 90-day mortality (8.1% vs 0%; p = 0.04). The predictive value of KGR was not influenced by sFLR volume or the timing of initial volume assessment when evaluated within 8 weeks after PVE.
  
  
  CONCLUSIONS
  Kinetic growth rate is a better predictor of postoperative morbidity and mortality after liver resection for small FLR than conventional measured volume parameters (ie, sFLR volume and degree of hypertrophy).
authors.affiliation: Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
authors.forename: Junichi
authors.initials: J
authors.lastname: Shindoh
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Truty
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Aloia
authors.forename: Steven A
authors.initials: SA
authors.lastname: Curley
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Zimmitti
authors.forename: Steven Y
authors.initials: SY
authors.lastname: Huang
authors.forename: Armeen
authors.initials: A
authors.lastname: Mahvash
authors.forename: Sanjay
authors.initials: S
authors.lastname: Gupta
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Wallace
authors.forename: Jean-Nicolas
authors.initials: JN
authors.lastname: Vauthey
mesh_terms: D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D015179:Colorectal Neoplasms / Q000473:pathology; D004621:Embolization, Therapeutic; D005260:Female; D006498:Hepatectomy; D048550:Hepatic Insufficiency / Q000401:mortality; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary / Q000601:surgery / Q000628:therapy*; D008115:Liver Regeneration; D008297:Male; D008875:Middle Aged; D011169:Portal Vein; D011183:Postoperative Complications / Q000401:mortality; D012372:ROC Curve; D018709:Statistics, Nonparametric; D015996:Survival Rate; D016896:Treatment Outcome