Korean J Hepatobiliary Pancreat Surg.  2013 Nov;17(4):143-151. 10.14701/kjhbps.2013.17.4.143.

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

• Kim HJ
• Kim CY
• Hur YH
• Koh YS
• Kim JC
• Cho CK
• Kim HJ

• KMID: 2083338
• DOI: http://doi.org/10.14701/kjhbps.2013.17.4.143

Abstract

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 x body weight (kg)0.732 x 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 < or =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.

Keyword

Liver volumetry; Future liver remnant; Liver resection; Liver failure

MeSH Terms

Bilirubin
Body Weight
Humans
Liver Failure
Liver Transplantation
Liver*
Retrospective Studies
Transplants
Bilirubin

Figure

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  Fig. 1 Virtual resection of the liver. The transection line of the virtual liver resection followed the middle hepatic vein. The middle hepatic vein was excluded from the virtual resection area.

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  Fig. 2 Correlation between RLV/SLV and RLV/TFLV. Some discordant results were observed.

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  Fig. 3 Correlation between RLV/SLV and serum total bilirubin level at POD 5 in all patients (A). No correlation was observed in LC-positive patients (B), however, Significant correlations were found between RLV/SLV and serum total bilirubin level in LC-negative patients (C). RLV/SLV showed a more close correlation with postoperative serum total bilirubin level than RLV/TFLV.

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