Volumetric analysis predicts hepatic dysfunction in patients undergoing major liver resection

Area of Science:

• Hepatology
• Surgical Oncology
• Radiology

Background:

• Major liver resection is associated with postoperative liver dysfunction.
• Preoperative liver enhancement techniques, such as portal vein embolization, are used to mitigate this risk.
• Clear selection criteria for these techniques are lacking.

Purpose of the Study:

• To utilize CT-based volumetric analysis to identify patients at highest risk for postoperative hepatic dysfunction.
• To establish predictive criteria for hepatic dysfunction following liver resection.

Main Methods:

• A retrospective analysis of 126 patients undergoing liver resection for colorectal metastasis between July 1999 and December 2000.
• CT scans were used for semiautomated contouring to determine the volume of resection.
• Hepatic dysfunction was defined by prothrombin time > 18 seconds or serum bilirubin > 3 mg/dl.

Main Results:

• The percentage of liver remaining strongly correlated with increased prothrombin time and bilirubin levels (P < 0.001).
• Patients with ≤25% of liver remaining after trisegmentectomy had a 90% incidence of hepatic dysfunction, versus 0% for those with >25% remaining (P < 0.0001).
• A lower percentage of liver remaining was a more specific predictor of hepatic dysfunction than the anatomic extent of resection (P = 0.003). Male sex and ≤25% liver remaining significantly increased risk (OR=1.89, P=0.027 and OR=3.09, P<0.0001, respectively).

Conclusions:

• Preoperative assessment of future liver volume remaining is crucial for identifying patients who will benefit from liver enhancement strategies.
• CT volumetry provides a more specific prediction of hepatic dysfunction than traditional measures.
• This approach can guide the selection of patients for preoperative interventions like portal vein embolization.