Liver function following extended hepatectomy can be accurately predicted using remnant liver volume to body weight ratio.

Abstract

BACKGROUND:

Standardised measurement of remnant liver volume (RLV), where total liver volume (TLV) is calculated from patients' body surface area (RLV-sTLV), has been advocated. Extrapolating the model of living donor liver transplantation, we showed in a pilot study that the simplified RLV/body weight ratio (RLVBWR) was accurate in assessing the functional limit of hepatectomy. The aim of the study was to compare in a prospective series of extended right hepatectomy the predictive value of the RLVBWR and the RLV-sTLV at a cut-off of 0.5% (RLVBWR0.5%) and 20% (RLV-sTLV20%), respectively.

METHODS:

We studied the impact of RLVBWR0.5% and of RLV-sTLV20% on three months morbidity and mortality in 74 non-cirrhotic patients operated on for malignant tumours. Of these, 47 patients who were not included in the initial pilot study were enrolled in a prospective validation cohort to reappraise the predictive value of each method.

RESULTS:

RLVBWR and RLV-sTLV were highly correlated (Pearson correlation coefficient, 0.966). Three months overall and severe morbidity (grade 3b-5) and mortality were significantly increased in groups RLVBWR ≤ 0.5% and RLV-sTLVs ≤ 20% compared to groups >0.5% and >20%, respectively. The sensitivity and specificity in predicting death from liver failure were 100 and 84.1% for RLVBWR0.5% and 60 and 94.2% for RLV-sTLV20%, respectively. Similar results were observed in the validation cohort for the RLVBWR0.5% (lack of statistical power for RLV-sTLV as only 2 patients showed a RLV-sTLV ≤ 20%).

CONCLUSIONS:

The RLVBWR0.5% is a method of assessing the remnant liver that is simple and as reliable as the standardised RLV-sTLV20%.

• Authors: Stéphanie Truant, Emmanuel Boleslawski, Géraldine Sergent, Emmanuelle Leteurtre, Alain Duhamel, Mohamed Hebbar, François-René Pruvot
• Journal: World journal of surgery (World J Surg) Vol. 39 Issue 5 Pg. 1193-201 (May 2015) ISSN: 1432-2323 [Electronic] United States
• PMID: 25561196 (Publication Type: Journal Article, Validation Study)

Topics

• Adult
• Aged
• Aged, 80 and over
• Body Surface Area
• Body Weight
• Female
• Hepatectomy (adverse effects, methods)
• Humans
• Liver (pathology, physiopathology)
• Liver Failure (etiology, mortality)
• Liver Function Tests
• Liver Neoplasms (surgery)
• Liver Regeneration
• Male
• Middle Aged
• Organ Size
• Prospective Studies
• Recovery of Function
• Sensitivity and Specificity