Difference of regeneration potential between healthy and diseased liver

We sought to evaluate total and segmental liver regeneration by comparing preoperative computed tomographic (CT) volumetry and CT volumetry on postoperative day (POD) 7 after a right hepatectomy, in patients with various status and surgical indications.

We included 36 patients who underwent right lobectomy for living donor liver transplantation (healthy group), and 29 for hepatocellular carcinoma treatment (disease group). All of the disease group patients were Child-Turcotte-Pugh (CTP) class A. The regeneration of lateral, medial segment and total remnant liver volumes were assessed on POD 7 using a CT-based program. Total volumes and segmental volumes were measured for total liver, future liver remnant (FLR), and liver remnant. We calculated total and segmental early regeneration indexes, defined as [(VLR-VFLR)/VFLR]×100, where VLR is volume of the liver remnant and VFLR is volume of the FLR.

The VLR at POD 7 showed a 72.9% increase in volume among the healthy versus 55% in the disease group, (P=.012) In the disease group, segmental volume and regeneration indexes were also significantly lower than among the healthy group: 59.0% versus 46.9% in the medial and 86.8% versus 57.7% in the lateral segment (P=.023 and P<.001) respectively.

The volume regeneration potential in diseased livers is significantly lower than that of a normal, healthy liver. So, we must consider a patient's liver status and volume profile before an extensive liver.