Standardized measurement of the future liver remnant prior to extended liver resection: Methodology and clinical associations

Background. There is no agreement regarding the preoperative measurement of ever volumes and the minimal safe size of the liver remnant after extended hepatectomy. Methods. In 20 patients with hepatobiliary malignancy and no under lying ch ronic liver disease, volumetric measurements of the liver remnant (segments 2 and 3 +/- I) were obtained before extended right lobectomy (right triseg mentectomy). The ratios of future liver remnant to total liver volume were calculated by using a formula based on body surface area. In 12 patients, r esponse to preoperative right trisectoral portal vein embolization was eval uated. In IT patients who underwent the planned resection, preoperative vol umes were correlated with biochemical and clinical outcome parameters. Results. The future liver remnants increased after portal vein embolization (26% versus 36%, P < .01). Smaller size liver remnants were associated wit h an increase in postoperative liver function tests (P < .05) and longer le ngths of hospital stay (P < .02). Preliminary data indicates an increase in major complications for liver volumes less than or equal to 25% (P = .02). Conclusions. A simple method of measurement provides an assessment of the l iver remnant before resection. It is useful in evaluating response to porta l vein embolization and in predicating the outcome before extended liver re sections.