title: Comparison of remnant to total functional liver volume ratio and remnant to standard liver volume ratio as a predictor of postoperative liver function after liver resection.
abstract: OBJECTIVE
  The future liver remnant (FLR) is usually calculated as a ratio of the remnant liver volume (RLV) to the total functional liver volume (RLV/TFLV). In liver transplantation, it is generally accepted that the ratio of the graft volume to standard liver volume (SLV) needs to be at least 30% to 40% to fit the hepatic metabolic demands of the recipient. The aim of this study was to compare RLV/TFLV versus RLV/SLV as a predictor of postoperative liver function and liver failure.
  
  
  METHODS
  CT volumetric measurements of RLV were obtained retrospectively in 74 patients who underwent right hemihepatectomy for a malignant tumor from January 2010 to May 2013. RLV and TFLV were obtained using CT volumetry, and SLV was calculated using Yu's formula: SLV (ml)=21.585×body weight (kg)(0.732)×height (cm)(0.225). The RLV/SLV ratio was compared with the RLV/TFLV as a predictor of postoperative hepatic function.
  
  
  RESULTS
  Postheptectomy liver failure (PHLF), morbidity, and serum total bilirubin level at postoperative day 5 (POD 5) were increased significantly in the group with the RLV/SLV ≤30% compared with the group with the RLV/SLV >30% (p=0.002, p=0.004, and p<0.001, respectively). But RLV/TFLV was not correlated with PHLF and morbidity (p=1.000 and 0.798, respectively). RLV/SLV showed a stronger correlation with serum total bilirubin level than RLV/TFLV (RLV/SLV vs. RLV/TFLV, R=0.706 vs. 0.499, R(2)=0.499 vs. 0.239).
  
  
  CONCLUSIONS
  RLV/SLV was more specific than RLV/TFLV in predicting the postoperative course after right hemihepatectomy. To determine the safe limit of hepatic resection, a larger-scaled prospective study is needed.
authors.affiliation: Department of Surgery, Chonnam National University College of Medicine, Gwangju, Korea.
authors.forename: Hee Joon
authors.initials: HJ
authors.lastname: Kim
authors.affiliation: Department of Surgery, Chonnam National University College of Medicine, Gwangju, Korea.
authors.forename: Choong Young
authors.initials: CY
authors.lastname: Kim
authors.affiliation: Department of Surgery, Chonnam National University College of Medicine, Gwangju, Korea.
authors.forename: Young Hoe
authors.initials: YH
authors.lastname: Hur
authors.affiliation: Department of Surgery, Chonnam National University College of Medicine, Gwangju, Korea.
authors.forename: Yang Seok
authors.initials: YS
authors.lastname: Koh
authors.affiliation: Department of Surgery, Chonnam National University College of Medicine, Gwangju, Korea.
authors.forename: Jung Chul
authors.initials: JC
authors.lastname: Kim
authors.affiliation: Department of Surgery, Chonnam National University College of Medicine, Gwangju, Korea.
authors.forename: Chol Kyoon
authors.initials: CK
authors.lastname: Cho
authors.affiliation: Department of Surgery, Chonnam National University College of Medicine, Gwangju, Korea.
authors.forename: Hyun Jong
authors.initials: HJ
authors.lastname: Kim
keywords: Future liver remnant; Liver failure; Liver resection; Liver volumetry