Significance of the Effective Remnant Liver Volume in Major Hepatectomies

Gruttadauria, Salvatore; Vasta, F.; Minervini, Marta Ida; Piazza, Tommaso; Arcadipane, Antonio; Marcos, Amadeo; Gridelli, Bruno

doi:10.1177/000313480507100313

Cited by 35 publications

(15 citation statements)

References 19 publications

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“…There are limited data for determining what percentage of the liver volume can be left in donors without their lives being jeopardized. A small liver remnant is the best predictor of hepatic dysfunction after liver resection 36. On the other hand, despite extensive surgical experience, MHV harvesting is still controversial because of the donor safety issues related to the disturbance of the venous drainage of the anterior sector, which can potentially jeopardize regeneration of the remnant liver 37, 38.…”

Section: Discussionmentioning

confidence: 99%

Utilization of elderly donors in living donor liver transplantation: When more is less?

et al. 2011

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An accepted definition of donor exclusion criteria has not been established for living donor liver transplantation (LDLT). The use of elderly donors to expand the living donor pool raises ethical concerns about donor safety. The aims of this study were (1) the comparison of the postoperative outcomes of living liver donors by age (!50 versus <50 years) and (2) the evaluation of the impact of the extent of right hepatectomy on donor outcomes. The study group included 150 donors who underwent donor right hepatectomy between October 2004 and April 2009. Extended criteria surgery (ECS) was defined as right hepatectomy with middle hepatic vein (MHV) harvesting or right hepatectomy resulting in an estimated remnant liver volume (RLV) less than 35%. The primary endpoints were donor outcomes in terms of donor complications graded according to the Clavien classification. Group 1 consisted of donors who were 50 years old or older (n ¼ 28), and group 2 consisted of donors who were less than 50 years old (n ¼ 122). At least 1 ECS criterion was present in 74% of donors: 57% had 1 criterion, and 17% had 2 criteria. None of the donors had grade 4 complications or died. The overall and major complication rates were similar in the 2 donor age groups [28.6% and 14.3% in group 1 and 32% and 8.2% in group 2 for the overall complication rates (P ¼ 0.8) and the major complication rates (P ¼ 0.2), respectively]. However, there was a significant correlation between the rate of major complications and the type of surgery in donors who were 50 years old or older. In LDLT, extending the limits of surgery comes at the price of more complications in elderly donors. Right hepatectomy with MHV harvesting and any procedure causing an RLV less than 35% should be avoided in living liver donors who are 50 years old or older.

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Section: Discussionmentioning

confidence: 99%

Utilization of elderly donors in living donor liver transplantation: When more is less?

et al. 2011

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“…Liver volume is closely related to LRF. 26 When RLV is below a certain threshold, the patient is prone to liver dysfunction, even FLF, and high mortality rate. 13 SRLV is used as an even more individualized approach to evaluate residual LRF of patients.…”

Section: Discussionmentioning

confidence: 99%

A Comprehensive Method for Predicting Fatal Liver Failure of Patients With Liver Cancer Resection

Lei

Nie

et al. 2015

Medicine

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There are many methods to assess liver function, but none of them has been verified as fully effective. The purpose of this study is to establish a comprehensive method evaluating perioperative liver reserve function (LRF) in patients with primary liver cancer (PLC).In this study, 310 PLC patients who underwent liver resection were included. The cohort was divided into a training set (n = 235) and a validation set (n = 75). The factors affecting postoperative liver dysfunction (POLD) during preoperative, intraoperative, and postoperative periods were confirmed by logistic regression analysis. The equation for calculating the preoperative liver functional evaluation index (PLFEI) was established; the cutoff value of PLFEI determined through analysis by receiver-operating characteristic curve was used to predict postoperative liver function.The data showed that body mass index, international normalized ratio, indocyanine green (ICG) retention rate at 15 minutes (ICGR15), ICG elimination rate, standard remnant liver volume (SRLV), operative bleeding volume (OBV), blood transfusion volume, and operative time were statistically different (all P < 0.05) between 2 groups of patients with and without POLD. The relationship among PLFEI, ICGR15, OBV, and SRLV is expressed as an equation of “PLFEI = 0.181 × ICGR15 + 0.001 × OBV − 0.008 × SRLV.” The cutoff value of PLFEI to predict POLD was −2.16 whose sensitivity and specificity were 90.3% and 73.5%, respectively. However, when predicting fatal liver failure (FLF), the cutoff value of PLFEI was switched to −1.97 whose sensitivity and specificity were 100% and 68.8%, respectively.PLFEI will be a more comprehensive, sensitive, and accurate index assessing perioperative LRF in liver cancer patients who receive liver resection. And keeping PLFEI <−1.97 is a safety margin for preventing FLF in PLC patients who underwent liver resection.

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“…Preoperative volume measurement is a good way to estimate the future remnant liver volume (FRLV) accurately, with evidence showing a high risk of postoperative liver failure after 1-stage resection when patients had a low FRLV (i.e., <30%). [ 8 ] Two-stage liver resection may be a good choice when patients have multiple huge lesions because of advanced AE, with the possibility that the first-stage procedure can improve future operability and reduce the associated operative risks at the second operation. In this article, we present our experience using 2-stage hepatectomy for the treatment of multiple huge AE disease.…”

Section: Introductionmentioning

confidence: 99%

Two-stage hepatectomy for multiple giant alveolar echinococcosis

Shen

Chen

et al. 2017

Medicine

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Alveolar echinococcosis is a chronically progressive and potentially fatal disease. Patients with multiple giant alveolar echinococcosis have a poor prognosis when radical resection cannot be achieved, but curative resection can be limited by low future remnant liver volumes. In these cases, 2-stage liver resection may be a better choice: after a first-stage hepatectomy with partial resection, liver regeneration is allowed in the residual liver before proceeding to the second-stage hepatectomy. In this study, we therefore retrospectively reviewed and evaluated the safety and feasibility of two-stage hepatectomy in patients with multiple giant alveolar echinococcosis.We reviewed the data for all patients who underwent 2-stage hepatectomy for multiple giant alveolar echinococcosis between August 2013 and December 2015 at either the West China Hospital of Sichuan University or the Hospital of Ganzi Tibetan Autonomous Prefecture.We identified 7 patients in whom 2-stage hepatectomy was completed. During the first-stage hepatectomy, 4 patients underwent right-sided hepatectomy and the other 3 underwent left-sided hepatectomy. The second-stage hepatectomies were successfully performed 3 months after the first-stage procedures. All patients had follow-up durations of >1 year; there were no cases of operation-related mortality, and no patients experienced disease recurrence.Two-stage hepatectomy is safe and feasible for patients with multiple giant alveolar echinococcosis.

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Significance of the Effective Remnant Liver Volume in Major Hepatectomies

Cited by 35 publications

References 19 publications

Utilization of elderly donors in living donor liver transplantation: When more is less?

Utilization of elderly donors in living donor liver transplantation: When more is less?

A Comprehensive Method for Predicting Fatal Liver Failure of Patients With Liver Cancer Resection

Two-stage hepatectomy for multiple giant alveolar echinococcosis

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