title: Measuring future liver remnant function prior to hepatectomy may guide the indication for portal vein occlusion and avoid posthepatectomy liver failure: a prospective interventional study.
abstract: Estimation of the future liver remnant function (eFLRF) can avoid post-hepatectomy liver failure (PHLF). In a previous study, a cutoff value of 2.3%/min/m2for eFLRF was a better predictor of PHLF than future liver remnant volume (FLRV%). In this prospective interventional study, investigating a management strategy aimed at avoiding PHLF, this cutoff value was the sole criterion assessing eligibility for hepatectomy, with or without portal vein occlusion (PVO).
  
  
  
  In 100 consecutive patients, eFLRF was determined using the formula: eFLRF = FLRV% × total liver function (TLF). Group 1 (eFLRF >2.3%/min/m2) underwent hepatectomy without preoperative intervention. Group 2 (eFLRF <2.3%/min/m2) underwent PVO and re-evaluation of eFLRF at 4-6 weeks. Hepatectomy was performed if eFLRF had increased to >2.3%/min/m2, but was considered contraindicated if the value remained lower.
  
  
  
  In group 1 (n = 93), 1 patient developed grade B PHLF. In group 2 (n = 7) no PHLF was recorded. Postoperative recovery of TLF in patients with preoperative eFLRF <2.3%/min/m2occurred more rapidly when PVO had been performed.
  
  
  
  A predefined cutoff for preoperatively calculated eFLRF can be used as a tool for selecting patients prior to hepatectomy, with or without PVO, thus avoiding PHLF and PHLF-related mortality.
authors.affiliation: Hepatobiliary, Endocrine and Transplantation Surgery, Antwerp University Hospital, Edegem, Belgium. Electronic address: Thiery.chapelle@uza.be.
authors.forename: Thiery
authors.initials: T
authors.lastname: Chapelle
authors.affiliation: Radiology, Antwerp University Hospital, Edegem, Belgium.
authors.forename: Bart
authors.initials: B
authors.lastname: Op de Beeck
authors.affiliation: Hepatobiliary, Endocrine and Transplantation Surgery, Antwerp University Hospital, Edegem, Belgium.
authors.forename: Geert
authors.initials: G
authors.lastname: Roeyen
authors.affiliation: Hepatobiliary, Endocrine and Transplantation Surgery, Antwerp University Hospital, Edegem, Belgium.
authors.forename: Bart
authors.initials: B
authors.lastname: Bracke
authors.affiliation: Hepatobiliary, Endocrine and Transplantation Surgery, Antwerp University Hospital, Edegem, Belgium.
authors.forename: Vera
authors.initials: V
authors.lastname: Hartman
authors.affiliation: Hepatobiliary, Endocrine and Transplantation Surgery, Antwerp University Hospital, Edegem, Belgium.
authors.forename: Kathleen
authors.initials: K
authors.lastname: De Greef
authors.affiliation: Nuclear Medicine, Antwerp University Hospital, Edegem, Belgium.
authors.forename: Ivan
authors.initials: I
authors.lastname: Huyghe
authors.affiliation: Radiology, Antwerp University Hospital, Edegem, Belgium.
authors.forename: Thijs
authors.initials: T
authors.lastname: Van der Zijden
authors.affiliation: Anaesthesiology, Antwerp University Hospital, Edegem, Belgium.
authors.forename: Stuart
authors.initials: S
authors.lastname: Morrison
authors.affiliation: Gastroenterology and Hepatology, Antwerp University Hospital, Edegem, Belgium.
authors.forename: Sven
authors.initials: S
authors.lastname: Francque
authors.affiliation: Hepatobiliary, Endocrine and Transplantation Surgery, Antwerp University Hospital, Edegem, Belgium.
authors.forename: Dirk
authors.initials: D
authors.lastname: Ysebaert
mesh_terms: D000328:Adult; D003661:Decision Support Techniques; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects*; D006801:Humans; D008099:Liver / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D017093:Liver Failure / Q000209:etiology / Q000517:prevention & control*; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D018579:Patient Selection; D011169:Portal Vein; D011237:Predictive Value of Tests; D011446:Prospective Studies; D020127:Recovery of Function; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome