title: New perspectives in the assessment of future remnant liver.
abstract: In order to achieve microscopic radical resection margins and thus better survival, surgical treatment of hepatic tumors has become more aggressive in the last decades, resulting in an increased rate of complex and extended liver resections. Postoperative outcomes mainly depend on the size and quality of the future remnant liver (FRL). Liver resection, when performed in the absence of sufficient FRL, inevitably leads to postresection liver failure. The current gold standard in the preoperative assessment of the FRL is computed tomography volumetry. In addition to the volume of the liver remnant after resection, postoperative function of the liver remnant is directly related to the quality of liver parenchyma. The latter is mainly influenced by underlying diseases such as cirrhosis and steatosis, which are often inaccurately defined until microscopic examination after the resection. Postresection liver failure remains a point of major concern that calls for accurate methods of preoperative FRL assessment. A wide spectrum of tests has become available in the past years, attesting to the fact that the ideal methodology has yet to be defined. The aim of this review is to discuss the current modalities available and new perspectives in the assessment of FRL in patients scheduled for major liver resection.
authors.affiliation: Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Kasia P
authors.initials: KP
authors.lastname: Cieslak
authors.forename: Jurgen H
authors.initials: JH
authors.lastname: Runge
authors.forename: Michal
authors.initials: M
authors.lastname: Heger
authors.forename: Jaap
authors.initials: J
authors.lastname: Stoker
authors.forename: Roelof J
authors.initials: RJ
authors.lastname: Bennink
authors.forename: Thomas M
authors.initials: TM
authors.lastname: van Gulik
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods; D005260:Female; D006488:Hemostasis, Surgical / Q000379:methods; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D017093:Liver Failure / Q000209:etiology / Q000401:mortality / Q000503:physiopathology*; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008866:Microsurgery / Q000379:methods; D018365:Neoplasm, Residual / Q000000981:diagnostic imaging* / Q000473:pathology*; D049268:Positron-Emission Tomography / Q000379:methods; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D011300:Preoperative Care / Q000379:methods; D011379:Prognosis; D018570:Risk Assessment; D015996:Survival Rate; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome