Measurement of liver volume and hepatic functional reserve as a guide to decision-making in resectional surgery for hepatic tumors

✍ Scribed by K Kubota; M Makuuchi; K Kusaka; T Kobayashi; K Miki; K Hasegawa; Y Harihara; T Takayama

• Publisher: John Wiley and Sons
• Year: 1997
• Tongue: English
• Weight: 194 KB
• Volume: 26
• Category: Article
• ISSN: 0270-9139
• DOI: 10.1002/hep.510260514

✦ Synopsis

The respective volumes of hepatic tumors and nontumor-reduce the size of the resected tissue and increase the volume of the remnant liver to approximate the target limits in indi-ous parenchyma of 50 patients requiring hepatectomy of more than one segment of Healey for tumor removal were measured viduals with large tumors or minimally abnormal liver function. (HEPATOLOGY 1997;26:1176-1181.) using computed tomography (Vol-CT). The volume estimated by Vol-CT was found to correlate with the real weight resected (P õ .0001) with a mean absolute error of 64.9 mL. The ratio With advances in perioperative care, including surgical of the nontumorous parenchymal volume of the resected liver techniques, liver resection for patients with chronic liver to that of the whole liver (R2) in 15 patients who underwent diseases can now be performed with low morbidity and morright or extended right hepatic lobectomy was 43% { 15%.

tality. [1][2][3][4][5][6] The operative procedures are usually selected on the Eight of 15 patients with R2s õ 60% underwent the procebasis of liver function and the location and extent of the dures without right portal vein embolization (PE). The other tumor. 6 In particular, as surgical procedures that involve seven with R2s exceeding 60% or an indocyanine green retenresection of a large proportion of the liver, such as right tion rate after 15 minutes (ICG15) of 10% to 20% underwent (RHL) and extended (ERHL) right hepatic lobectomy, are PE: in six of seven, the nontumorous parenchyma of the right occasionally associated with postoperative liver failure, 7 the hepatic lobe became atrophic and in all seven, the volume of decision to perform them should be taken with care for each the remaining left hepatic lobe increased with a decrease in individual. Recently, to improve the safety of RHL, right the mean R2 from 62% { 14% to 55% { 8% (P Å .0006). In portal vein embolization (PE) has been employed, according the remaining 35 who underwent other hepatectomy proceto the remnant liver volume, to reduce the size of the liver dures, R2s also remained õ60%. Overall, at surgery, in 27 region to be resected and induce hypertrophy of the contrawith normal liver function (ICG15 õ 10%), R2s exceeded lateral liver. 8 Thus, to select the most appropriate surgical 60% in one, remained at 50% to 60% in five, and õ50% in procedure, including PE, the extent of liver resection, in 21, whereas 23 patients except for one with an ICG15 exterms of the resection volume to whole liver volume ratio, ceeding 10%, had R2s of õ50%. The postoperative serum should be estimated precisely. total bilirubin levels in 84% of the patients remained within Clinically, the liver volume has been measured to evaluate the normal range and there was no surgery-related mortality.

liver regeneration after hepatectomy using several diagnostic In conclusion, 1) Vol-CT can accurately assess the extent of imaging techniques, such as scintigraphy, 9,10 ultrasound, 11,12 liver resection, 2) individuals with normal liver function can single-photon emission computed tomography, 13,14 comundergo resection of up to 60% of the nontumorous parenputed tomography (CT), [15][16][17] and magnetic resonance imchyma without the need for PE, and 3) PE can be used to aging. 17 Because it was first reported by Heymsfield et al., 18 liver volume determination by CT has been used in the fields of liver resection 17,19,20 and transplantation [21][22][23][24] and for evalu-Abbreviations: RHL, right hepatic lobectomy; ERHL, extended right hepatic lobecating the progression of various diseases. 25 Furthermore, voltomy; PE, right portal vein embolization; CT, computed tomography; Vol-CT, volumetumetric measurement of the liver using CT (Vol-CT) has ric measurement of the liver using CT; ICG15, indocyanine green (0.5 mg/kg) retention been shown to represent the volume precisely upon comparirate after 15 minutes; AE, absolute error; LHL, left hepatic lobectomy; VR, liver volume including the tumor to be resected; WR, weight of the resected liver specimen; ELHL, son with the actual resected liver weight, and recently it extended left hepatic lobectomy; HCC, hepatocellular carcinoma; VW, whole liver has been used to assess graft sizes for living-related liver volume including the tumor; VT, tumor volume; R1, VR/VW 1100; R2, (VR-VT)/ transplantation. 21-24 However, it has not yet been fully dis-(VW-VT) 1100.