Volumetric Analysis Predicts Hepatic Dysfunction in Patients Undergoing Major Liver Resection

Shoup, Margo; Gönen, Mithat; D’Angelica, Michael I.; Jarnagin, William R.; DeMatteo, Ronald P.; Schwartz, Lawrence H.; Tuorto, Scott; Blumgart, Leslie H.; Fong, Yuman

doi:10.1016/s1091-255x(02)00370-0

Cited by 454 publications

(301 citation statements)

References 13 publications

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“…With hepatic resection an amount of liver parenchyma is lost, and in the remnant hepatocytes arise both regeneration and necrosis. The remnant liver must therefore be able to overcome the necrosis, preserving or recovering an adequate synthetic ability [22] ; as a consequence, there must be an adequate and functional FLRV to avoid PHLF [23] . Despite this, there is no uniform consensus among hepatic surgeons on the amount of liver volume that can be safely resected, with a wide range of reported values [24,25] .…”

Section: Introductionmentioning

confidence: 99%

Liver volumetry: Is imaging reliable? Personal experience and review of the literature

D’Onofrio

Robertis

Demozzi

et al. 2014

WJR

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The amount of the future liver remnant volume is fundamental for hepato-biliary surgery, representing an important potential risk-factor for the development of post-hepatectomy liver failure. Despite this, there is no uniform consensus about the amount of hepatic parenchyma that can be safely resected, nor about the modality that should be chosen for this evaluation. The pre-operative evaluation of hepatic volume, along with a precise identification of vascular and biliar anatomy and variants, are therefore necessary to reduce surgical complications, especially for extensive resections. Some studies have tried to validate imaging methods [ultrasound, computed tomography (CT), magnetic resonance imaging] for the assessment of liver volume, but there is no clear evidence about the most accurate method for this evaluation. Furthermore, this volumetric evaluation seems to have a certain degree of error, tending to overestimate the actual hepatic volume, therefore some conversion factors, which should give a more reliable evaluation of liver volume, have been proposed. It is widespread among non-radiologists the use of independent software for an off-site volumetric analysis, performed on digital imaging and communications in medicine images with their own personal computer, but very few studies have provided a validation of these methods. Moreover, while the pre-transplantation volumetric assessment is fundamental, it remains unclear whether it should be routinely performed in all patients undergoing liver resection. In this editorial the role of imaging in the estimation of liver volume is discussed, providing a review of the most recent literature and a brief personal series of correlations between liver volumes and resection specimens' weight, in order to assess the precision of the volumetric CT evaluation.

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Section: Introductionmentioning

confidence: 99%

Liver volumetry: Is imaging reliable? Personal experience and review of the literature

D’Onofrio

Robertis

Demozzi

et al. 2014

WJR

View full text Add to dashboard Cite

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“…The morbidity and mortality after hepatic metastasectomia is usually related to progression of liver failure that depends on the resection volume as well as contribution of coexisting liver disease [10][11][12]. Previous researches in this field provide controversial data about the correlation between the volume of damaged hepatic tissue and life expectancy.…”

Section: Discussionmentioning

confidence: 99%

Case report: High-volumetric atypical hemihepatectomy in patient with colorectal cancer with extensive metastatic disease

Sjomina¹,

Pavlova²,

Gashenko³

et al. 2017

Liver Pancreat Sci

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Hepatic metastasectomy in colorectal cancer is becoming a routine procedure, however the presence of extrahepatic metastatic disease worsens the life expectancy. A high-volumetric hepatic resection in case of multiple liver metastases might be performed after iatrogenic liver hypertrophy aimed to enlarge functional liver volume. Ligation or embolization of portal vein can be done. The outcome of the procedure is significantly improved using newest chemotherapy regimens and biological medications. We report a case with successful combined therapy of a 49-year-old male with colorectal cancer and bilateral extended metastatic process in liver and lungs.

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“…Generally, hepatectomy can be safely performed in patients with normal liver function when they have SFLV of over 250 ml or SFLV ratio over 25% to 30%. However, the SFLV ratio of patients with hepatic dysfunction or cirrhosis must exceed 40% (Shirabe et al, 1999;Shoup et al, 2003;Schroeder et al, 2006;Clavien et al, 2007;Suda et al, 2009).…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Computer-Assisted Quantitative Volumetric Analysis for Pre-Operative Resectability Assessment of Huge Hepatocellular Carcinoma

Tang

Yan²,

Zhou³

et al. 2013

Asian Pacific Journal of Cancer Prevention

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Purpose: Hepatic resection is arguably the preferred treatment for huge hepatocellular carcinoma (H-HCC). Estimating the remnant liver volume is therefore essential. This study aimed to evaluate the feasibility of using computer-assisted volumetric analysis for this purpose. Methods: The study involved 40 patients with H-HCC. Laboratory examinations were conducted, and a contrast CT-scan revealed that 30 cases out of the participating 40 had single-lesion tumors. The remaining 10 had less than three satellite tumors. With the consensus of the team, two physicians conducted computer-assisted 3D segmentation of the liver, tumor, and vessels in each case. Volume was automatically computed from each segmented/labeled anatomical field. To estimate the resection volume, virtual lobectomy was applied to the main tumor. A margin greater than 1 cm was applied to the satellite tumors. Resectability was predicted by computing a ratio of functional liver resection (R) as (VresectedVtumor)/(Vtotal-Vtumor) x 100%, applying a threshold of 50% and 60% for cirrhotic and non-cirrhotic cases, respectively. This estimation was then compared with surgical findings. Results: Out of the 22 patients who had undergone hepatectomies, only one had an R that exceeded the threshold. Among the remaining 18 patients with non-resectable H-HCC, 12 had Rs that exceeded the specified ratio and the remaining 6 had Rs that were < 50%. Four of the patients who had Rs less than 50% underwent incomplete surgery due to operative findings of more extensive satellite tumors, vascular invasion, or metastasis. The other two cases did not undergo surgery because of the high risk involved in removing the tumor. Overall, the ratio of functional liver resection for estimating resectability correlated well with the other surgical findings. Conclusion: Efficient pre-operative resectability assessment of H-HCC using computer-assisted volumetric analysis is feasible.

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Volumetric Analysis Predicts Hepatic Dysfunction in Patients Undergoing Major Liver Resection

Cited by 454 publications

References 13 publications

Liver volumetry: Is imaging reliable? Personal experience and review of the literature

Liver volumetry: Is imaging reliable? Personal experience and review of the literature

Case report: High-volumetric atypical hemihepatectomy in patient with colorectal cancer with extensive metastatic disease

Evaluation of Computer-Assisted Quantitative Volumetric Analysis for Pre-Operative Resectability Assessment of Huge Hepatocellular Carcinoma

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