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KMID : 0870420130170040143
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Korean Journal of Hepato-Biliary-Pancreatic Surgery
2013 Volume.17 No. 4 p.143 ~ p.151
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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
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Kim Hee-Joon
Kim Choong-Young
Hur Young-Hoe
Koh Yang-Seok
Kim Jung-Chul
Cho Chol-Kyoon
Kim Hyun-Jong
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Abstract
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Backgrounds/Aims: 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, R2=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.
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KEYWORD
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Liver volumetry, Future liver remnant, Liver resection, Liver failure
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