title: Liver function following extended hepatectomy can be accurately predicted using remnant liver volume to body weight ratio.
abstract: BACKGROUND
  Standardised measurement of remnant liver volume (RLV), where total liver volume (TLV) is calculated from patients' body surface area (RLV-sTLV), has been advocated. Extrapolating the model of living donor liver transplantation, we showed in a pilot study that the simplified RLV/body weight ratio (RLVBWR) was accurate in assessing the functional limit of hepatectomy. The aim of the study was to compare in a prospective series of extended right hepatectomy the predictive value of the RLVBWR and the RLV-sTLV at a cut-off of 0.5% (RLVBWR0.5%) and 20% (RLV-sTLV20%), respectively.
  
  
  METHODS
  We studied the impact of RLVBWR0.5% and of RLV-sTLV20% on three months morbidity and mortality in 74 non-cirrhotic patients operated on for malignant tumours. Of these, 47 patients who were not included in the initial pilot study were enrolled in a prospective validation cohort to reappraise the predictive value of each method.
  
  
  RESULTS
  RLVBWR and RLV-sTLV were highly correlated (Pearson correlation coefficient, 0.966). Three months overall and severe morbidity (grade 3b-5) and mortality were significantly increased in groups RLVBWR ≤ 0.5% and RLV-sTLVs ≤ 20% compared to groups >0.5% and >20%, respectively. The sensitivity and specificity in predicting death from liver failure were 100 and 84.1% for RLVBWR0.5% and 60 and 94.2% for RLV-sTLV20%, respectively. Similar results were observed in the validation cohort for the RLVBWR0.5% (lack of statistical power for RLV-sTLV as only 2 patients showed a RLV-sTLV ≤ 20%).
  
  
  CONCLUSIONS
  The RLVBWR0.5% is a method of assessing the remnant liver that is simple and as reliable as the standardised RLV-sTLV20%.
authors.affiliation: Service de Chirurgie Digestive et Transplantation, Hôpital HURIEZ, Rue M. Polonovski, CHU, Univ Nord de France, 59000, Lille, France, stephanie.truant@chru-lille.fr.
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Truant
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Boleslawski
authors.forename: Géraldine
authors.initials: G
authors.lastname: Sergent
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Leteurtre
authors.forename: Alain
authors.initials: A
authors.lastname: Duhamel
authors.forename: Mohamed
authors.initials: M
authors.lastname: Hebbar
authors.forename: François-René
authors.initials: FR
authors.lastname: Pruvot
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001830:Body Surface Area; D001835:Body Weight; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D008099:Liver / Q000473:pathology* / Q000503:physiopathology; D017093:Liver Failure / Q000209:etiology* / Q000401:mortality; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000601:surgery*; D008115:Liver Regeneration; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D011446:Prospective Studies; D020127:Recovery of Function; D012680:Sensitivity and Specificity