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The small remnant liver after major liver resection: how common and how relevant?
Cengizhan Yigitler1, Olivier Farges, Reza Kianmanesh
1Department of Hepatopancreatobiliary Surgery, Beaujon Hospital [Assistance Publique-Hôpitaux de Paris], University Paris 7, France.
Abstract:
The maximum extent of hepatic resection compatible with a safe postoperative outcome is unknown. The study goal was to determine the incidence and impact of a small remnant liver volume after major liver resection in patients with normal liver parenchyma. Among 265 major hepatectomies performed at our institution (1998 to 2000), 138 patients with normal liver and a remnant liver volume (RLV) systematically calculated from the ratio of RLV to functional liver volume (FLV) were studied. Patients were divided into five groups based on RLV-FLV ratio from /=60%. Kinetics of postoperative liver function tests were correlated with RLV. Postoperative complications were stratified by RLV-FLV ratios. Ninety patients (65%) underwent resection of up to four Couinaud segments. The RLV-FLV ratio was