The Future Liver Remnant : Definition, Evaluation, and Management

Area of Science:

• Hepatobiliary Surgery
• Surgical Oncology
• Liver Regeneration

Background:

• Major hepatectomy necessitates careful evaluation of the future liver remnant (FLR).
• Ensuring adequate FLR volume is critical for patient survival and preventing post-operative liver failure.
• The complexity of liver resections requires strategies to manage and augment the FLR.

Purpose of the Study:

• To review the optimal future liver remnant (FLR) volume required for major hepatectomy.
• To analyze techniques for augmenting FLR volume when it is insufficient.
• To discuss growth parameters for assessing FLR adequacy and management of inadequate growth.

Main Methods:

• Literature review of studies on major hepatectomy and FLR management.
• Analysis of current surgical techniques for FLR augmentation (e.g., portal vein ligation, associating liver partition and portal vein ligation).
• Evaluation of methods for assessing FLR volume and predicting post-operative liver function.

Main Results:

• Optimal FLR volume varies based on patient factors and planned resection extent.
• Surgical techniques like portal vein embolization and associating liver partition and portal vein ligation can effectively increase FLR volume.
• Specific imaging and biochemical parameters can predict FLR growth and post-operative outcomes.

Conclusions:

• Determining optimal FLR volume is paramount in major hepatectomy planning.
• Various surgical and interventional techniques exist to augment FLR volume, improving outcomes.
• Close monitoring of FLR growth and timely intervention are essential for managing patients undergoing major liver resections.