Precision in Liver Surgery: A Comparative Analysis of Volumetry Techniques

Future liver remnant volume (FLRV) is a critical determinant of safety for hepatectomy. This study assesses concordance between imaging-based measured FLRV (mFLRV), and body surface area (BSA)-based standardized FLRV (sFLRV), and their association with post-hepatectomy complications.

All major hepatectomy between 1999 and 2021 were assessed for agreement between mFLRV and sFLRV using concordance correlation coefficient (CCC). Association between each method and major postoperative complications, post-hepatectomy liver failure (PHLF), or grade 4/5 morbidity was compared using logistic regression model and area under the receiver-operating characteristic (AUC) curve to evaluate the discriminatory power of each volumetry method separately.

A total of 1749 patients were included, 49% were female, median age was 60 years, 70.2% had metastatic disease, and 49.7% received preoperative chemotherapy. Median sFLRV (41.3%) was higher than mFLRV (39.4%). Major complications were observed in 5.1% (n = 90). Concordance between mFLRV and sFLRV was moderate, CCC = 0.78 (95% CI 0.75-0.79) but was poor (CCC = 0.39; 95% CI 0.32-0.43) among patients with mFLRV ≤ 35% (n = 528). In this subset, sFLRV overestimated remnant volume in 63% (n = 333) with ≥ 5% overprediction in 145 patients (27.5%). Factors associated with ≥ 5% variation were lower weight (p = 0.003), lower BMI (p = 0.003), and lower BSA (p = 0.004). Both methods performed similarly in predicting major complications with AUC of 0.64 and 0.63 for sFLRV and mFLRV, respectively.

Imaging- and BSA-based volumetry are moderately correlated, with poor concordance among patients with smaller FLRV where sFLRV overestimated remnant volume. Both techniques can be safely used for volumetric assessment before major hepatectomy.