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

Abstract

The respective volumes of hepatic tumors and nontumorous parenchyma of 50 patients requiring hepatectomy of more than one segment of Healey for tumor removal were measured using computed tomography (Vol-CT). The volume estimated by Vol-CT was found to correlate with the real weight resected (P < .0001) with a mean absolute error of 64.9 mL. The ratio of the nontumorous parenchymal volume of the resected liver to that of the whole liver (R2) in 15 patients who underwent right or extended right hepatic lobectomy was 43% +/- 15%. Eight of 15 patients with R2s < 60% underwent the procedures without right portal vein embolization (PE). The other seven with R2s exceeding 60% or an indocyanine green retention rate after 15 minutes (ICG15) of 10% to 20% underwent PE: in six of seven, the nontumorous parenchyma of the right hepatic lobe became atrophic and in all seven, the volume of the remaining left hepatic lobe increased with a decrease in the mean R2 from 62% +/- 14% to 55% +/- 8% (P = .0006). In the remaining 35 who underwent other hepatectomy procedures, R2s also remained <60%. Overall, at surgery, in 27 with normal liver function (ICG15 < 10%), R2s exceeded 60% in one, remained at 50% to 60% in five, and <50% in 21, whereas 23 patients except for one with an ICG15 exceeding 10%, had R2s of <50%. The postoperative serum total bilirubin levels in 84% of the patients remained within the normal range and there was no surgery-related mortality. In conclusion, 1) Vol-CT can accurately assess the extent of liver resection, 2) individuals with normal liver function can undergo resection of up to 60% of the nontumorous parenchyma without the need for PE, and 3) PE can be used to reduce the size of the resected tissue and increase the volume of the remnant liver to approximate the target limits in individuals with large tumors or minimally abnormal liver function.

Interleukin-6 inhibits oxidative injury and necrosis after extreme liver resection

“…Greater than 75% to 80% resection, as would be required in patients with larger, central, or multiple metastases, is poorly tolerated and is associated with a high mortality rate because of liver failure. 1,20 This inability to tolerate extended liver resection contributes to the fact that more than 75% of patients with isolated liver metastases are not candidates for liver resection. 21 Although a clinically critical question, the mechanisms resulting in liver failure and death after extensive hepatectomy are not clear.…”

Clinical practice guidelines for the management of biliary tract cancers 2015: the 2nd English edition

“…(Grade 1, evidence level C) Statement: For treatment of bile duct cancers, the surgical resection combined with extended hepatectomy is often required for curative resection. As the resection volume of liver is different in each case, the future remnant liver volume should be considered case by case for prediction of postoperative liver function [135]. The ICG retention rate at 15min (ICGR15) or other ICG clearance tests are usually used as indicators for liver function [87,124,127,136,137].…”

Ultrasound-guided liver resection: Early experience in a district general hospital

“…Regardless of whether the patients were presumed to have underlying liver disease, indications for operation were established on the basis of liver function reserve, tumor stage and volume of the remnant liver [11]. In patients with bilirubin concentration below 2.0 mg/dl the surgical strategy was planned according to the flowchart published by Makuuchi and Kokudo [12].…”