Three hundred and one consecutive extended right hepatectomies: evaluation of outcome based on systematic liver volumetry.

Abstract

OBJECTIVE(S):

This study aimed to determine the effect of preoperative liver volumetry on postoperative outcomes after extended right hepatectomy. Primary end point was to evaluate whether future liver remnant (FLR)/standardized liver volume ratio (sFLR) >20% is sufficient for a safe hepatic resection. Secondary end point was to assess whether preoperative portal vein embolization (PVE) is associated with improved outcome in patients with initial sFLR ≤ 20%.

BACKGROUND DATA:

An sFLR >20% of the total liver volume has been proposed as sufficient for safe hepatic resection, but this concept has not been validated in a large series. In addition, recent reports suggest preoperative PVE is indicated for sFLR <30%.

METHODS:

The impact of sFLR and PVE on short-term outcomes (postoperative complications, liver insufficiency, and 90-day mortality) was analyzed in 301 consecutive patients after extended right hepatectomy. Liver volumetry accounted for partial resection of segment IV. Liver insufficiency was defined as peak postoperative serum bilirubin >7 mg/dL. Predictors of liver insufficiency were identified by multivariate logistic regression.

RESULTS:

Postoperative liver insufficiency occurred in 45 patients (15%) and accounted for 61% of deaths. Among 290 patients who underwent liver volumetry, sFLR was <20% in 38 patients, 20.1% to 30% in 144, and ≥ 30% in 108. Rates of postoperative liver insufficiency and death from liver failure were similar between patients with sFLR 20.1% to 30% and sFLR ≥ 30% but higher in patients with sFLR ≤ 20% (P 0.05). Postoperative outcomes were similar between patients with increase in sFLR from ≤ 20% to >20% after PVE and patients with initial sFLR >20%. Multivariate analysis revealed that body mass index >25 kg/m2, intraoperative blood transfusion, and sFLR ≤ 20% (odds ratio = 3.18; 95% CI, 1.34-7.54) independently predicted postoperative liver insufficiency.

CONCLUSIONS:

Systematic measurement of FLR volume is important to select patients for PVE and extended right hepatectomy. A sFLR >20% is sufficient for safe hepatic resection and sFLR 20.1% to 30% is not an indication for preoperative PVE.

• Authors: Yoji Kishi, Eddie K Abdalla, Yun Shin Chun, Daria Zorzi, David C Madoff, Michael J Wallace, Steven A Curley, Jean-Nicolas Vauthey
• Journal: Annals of surgery (Ann Surg) Vol. 250 Issue 4 Pg. 540-8 (Oct 2009) ISSN: 1528-1140 [Electronic] United States
• PMID: 19730239 (Publication Type: Journal Article)

Chemical References

• Bilirubin

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Bilirubin (blood)
• Chi-Square Distribution
• Child
• Embolization, Therapeutic
• Endpoint Determination
• Female
• Hepatectomy (methods, mortality)
• Humans
• Liver (anatomy & histology, surgery)
• Liver Function Tests
• Logistic Models
• Male
• Middle Aged
• Outcome and Process Assessment, Health Care
• Patient Selection
• Portal Vein
• Postoperative Complications (mortality)
• Preoperative Care
• Retrospective Studies
• Risk Factors
• Statistics, Nonparametric