Skip to main content

Advertisement

SpringerLink
Log in

Postoperative Liver Dysfunction and Future Remnant Liver: Where Is the Limit?

Results of a Prospective Study

  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

The future remnant liver (FRL) limit for safe major hepatectomy with low risk of postoperative liver failure has not yet been well defined.

Methods

Between April 2000 and September 2004, every patient scheduled for major hepatectomy in our institution underwent CT-volumetry of FRL. Patients with FRL <25% underwent portal vein embolization (PVE). Exclusion criteria were PVE, associated vascular resection and liver cirrhosis. The FRL was correlated with short-term results in patients with normal liver (group A) and those with impaired liver function secondary to neoadjuvant chemotherapy or cholestasis (bilirubin >2 mg/100 ml) (group B). Liver dysfunction was defined as both PT <50% and serum bilirubin level >5 mg/100 ml for three or more consecutive days.

Results

A total of 119 patients were analyzed, 72 in group A and 47 in group B. The FRL value was the only significant risk factor for postoperative liver dysfunction in the univariate and multivariate analysis (p = 0.009). The FRL did not correlate with postoperative mortality and morbidity. Bilirubin and prothrombin time (PT) on days 3 and 7 were significantly correlated to FRL in both groups. In group A, patients with postoperative liver dysfunction had a FRL<30% (3 versus 0; p = 0.005). According to receiving operator characteristic (ROC) curve analysis, a FRL value of 26.5% predicted postoperative liver dysfunction with 66.7% sensitivity, 97.1% specificity, 50% positive predictive value (PPV), and 98.5% negative predictive value (NPV). In group B, patients with postoperative liver dysfunction had a FRL <35% (4 versus 0; p = 0.027). According to ROC curve analysis, a FRL value of 31.05% predicted postoperative liver dysfunction with 75% sensitivity, 79.1% specificity, 25% PPV, and 97.1% NPV.

Conclusions

Hepatectomy can be considered safe when FRL is >26.5% in patients with healthy liver and >31% in patients with impaired liver function.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Imamura H, Seyama Y, Kokudo N, et al. (2004) Single and multiple resections of multiple hepatic metastases of colorectal origin. Surgery 135:508–517

    Article  PubMed  Google Scholar 

  2. Poon RT, Fan ST, Lo CM, et al. (2001) Improving survival results after resection of hepatocellular carcinoma: a prospective study of 377 patients over 10 years. Ann Surg 234:63–70

    Article  PubMed  CAS  Google Scholar 

  3. Fan ST, Lo CM, Liu CL, et al. (1999) Hepatectomy for hepatocellular carcinoma: toward zero hospital deaths. Ann Surg 229:322–330

    Article  PubMed  CAS  Google Scholar 

  4. Torzilli G, Makuuchi M, Inoue K, et al. (1999) No-mortality liver resection for hepatocellular carcinoma in cirrhotic and noncirrhotic patients. Is there a way? A prospective analysis of our approach. Arch Surg 134:984–992

    Article  PubMed  CAS  Google Scholar 

  5. Jarnagin WR, Gonen M, Fong Y, et al. (2002) Improvement in perioperative outcome after hepatic resection: analysis of 1,803 consecutive cases over the past decade. Ann Surg 236:397–406

    Article  PubMed  Google Scholar 

  6. Ferrero A, Polastri R, Muratore A, et al. (2004) Extensive resections for colorectal liver metastases. J Hepatobiliary Pancreat Surg 11:92–96

    Article  PubMed  Google Scholar 

  7. Shoup M, Gonen M, D’Angelica M, et al. (2003) Volumetric analysis predicts hepatic dysfunction in patients undergoing major liver resection. J Gastrointest Surg 7:325–330

    Article  PubMed  Google Scholar 

  8. Vauthey JN, Baer HU, Guastella T, et al. (1993) Comparison of outcome between extended and nonextended liver resections for neoplasms. Surgery 114:968–975

    PubMed  CAS  Google Scholar 

  9. Imamura H, Shimada R, Kubota M, et al. (1999) Preoperative portal vein embolization: an audit of 84 patients. Hepatology 29:1099–1105

    Article  PubMed  CAS  Google Scholar 

  10. Abdalla EK, Hicks ME, Vauthey JN. (2001) Portal vein embolization: rationale, technique, future prospects. Br J Surg 88:165–175

    Article  PubMed  CAS  Google Scholar 

  11. Imamura H, Seyama Y, Kokudo N, et al. (2003) One thousand fifty-six hepatectomies without mortality in 8 years. Arch Surg 138:1198–1206

    Article  PubMed  Google Scholar 

  12. Capussotti L, Ferrero A, Viganò L, et al. (2006) Bile leakage and liver resection: where is the risk? Arch Surg 141:690–694

    Article  PubMed  Google Scholar 

  13. Rubbia-Brandt L, Audard V, Sartoretti P, et al. (2004) Severe hepatic sinusoidal obstruction associated with oxaliplatin-based chemotherapy in patients with metastatic colorectal cancer. Ann Oncol 15:460–466

    Article  PubMed  CAS  Google Scholar 

  14. Karoui M, Penna C, Amin-Hashem M, et al. (2006) Influence of preoperative chemotherapy on the risk of major hepatectomy for colorectal liver metastases. Ann Surg 243:1–7

    Article  PubMed  Google Scholar 

  15. Vauthey JN, Pawlik TM, Ribero D, et al. (2006) Chemotherapy regimen predicts steatohepatitis and an increase in 90-day mortality after surgery for hepatic colorectal metastases. J Clin Oncol. 24:2065–2072

    Article  PubMed  CAS  Google Scholar 

  16. Belghiti J, Hiramatsu K, Benoist S, et al. (2000) Seven hundred forty-seven hepatectomies in the 1990s: an update to evaluate the actual risk of liver resection. J Am Coll Surg 191:38–46

    Article  PubMed  CAS  Google Scholar 

  17. The Brisbane 2000 Terminology of Liver Anatomy and Resection. (2000) Terminology Committee of the International Hepato-Pancreato-Biliary Association. HPB 2:333–339

    Google Scholar 

  18. Wakabayashi H, Ishimura K, Okano K, et al. (2002) Application of preoperative portal vein embolization before major hepatic resection in patients with normal or abnormal liver parenchyma. Surgery 131:26–33

    Article  PubMed  Google Scholar 

  19. Azoulay D, Castaing D, Smail A, et al. (2000) Resection of nonresectable liver metastases from colorectal cancer after percutaneous portal vein embolization. Ann Surg 231:480–486

    Article  PubMed  CAS  Google Scholar 

  20. Suc B, Panis Y, Belghiti J, et al. (1992) ‘Natural history’ of hepatectomy. Br J Surg 79:39–42

    Article  PubMed  CAS  Google Scholar 

  21. Vauthey JN, Chaoui A, Do KA, et al. (2000) Standardized measurement of the future liver remnant prior to extended liver resection: methodology and clinical associations. Surgery 127:512–519

    Article  PubMed  CAS  Google Scholar 

  22. Yigitler C, Farges O, Kianmanesh R, et al. (2003) The small remnant liver after major liver resection: how common and how relevant? Liver Transpl 9:S18–25

    Article  PubMed  Google Scholar 

  23. Matsumata T, Kanematsu T, Okudaira Y, et al. (1987) Postoperative mechanical ventilation preventing the occurrence of pleural effusion after hepatectomy. Surgery 102:493–497

    PubMed  CAS  Google Scholar 

  24. Nagano Y, Togo S, Tanaka K, et al. (2003) Risk factors and management of bile leakage after hepatic resection. World J Surg 27:695–698

    Article  PubMed  Google Scholar 

  25. Takeda K, Togo S, Kunihiro O, et al. (2002) Clinicohistological features of liver failure after excessive hepatectomy. Hepatogastroenterology 49:354–358

    PubMed  Google Scholar 

  26. Schindl MJ, Millar AM, Redhead DN, et al. (2006) The adaptive response of the reticuloendothelial system to major liver resection in humans. Ann Surg 243:507–514

    Article  PubMed  Google Scholar 

  27. Di Stefano DR, de Baere T, Denys A, et al. (2005) Preoperative percutaneous portal vein embolization: evaluation of adverse events in 188 patients. Radiology 234:625–630

    Article  PubMed  Google Scholar 

  28. Kodama Y, Shimizu T, Endo H, et al. (2002) Complications of percutaneous transhepatic portal vein embolization. J Vasc Interv Radiol 13:1233–1237

    Article  PubMed  Google Scholar 

  29. Schindl MJ, Redhead DN, Fearon KC, et al. (2005) The value of residual liver volume as a predictor of hepatic dysfunction and infection after major liver resection. Gut 54:289–296

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Author notes

  1. Alessandro Ferrero

    Present address: Ospedale Mauriziano “Umberto I,” Largo Turati, 62-10128, Torino, Italy

Authors and Affiliations

  1. Unit of Surgical Oncology, Institute for Cancer Research and Treatment, Candiolo, Italy

    Alessandro Ferrero, Luca Viganò, Roberto Polastri, Andrea Muratore & Lorenzo Capussotti

  2. Department of Radiology, Institute for Cancer Research and Treatment, Candiolo, Italy

    Haris Eminefendic & Daniele Regge

Authors
  1. Alessandro Ferrero
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Luca Viganò
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Roberto Polastri
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Andrea Muratore
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Haris Eminefendic
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Daniele Regge
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Lorenzo Capussotti
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alessandro Ferrero.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ferrero, A., Viganò, L., Polastri, R. et al. Postoperative Liver Dysfunction and Future Remnant Liver: Where Is the Limit?. World J Surg 31, 1643–1651 (2007). https://doi.org/10.1007/s00268-007-9123-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-007-9123-2

Keywords

Search

Navigation