American Surgical Association
2009 Annual Meeting Abstracts

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Impact of Future Liver Remnant Volume on Outcome in 301 Consecutive Extended Right Hepatectomies
*Jean-Nicolas Vauthey, *Yoji Kishi, *Yun S Chun, *David C Madoff, *Martin Palavecino, *Michael J Wallace, *Eddie K Abdalla, Steven A Curley
The University of Texas M. D. Anderson Cancer Center, Houston, TX

OBJECTIVE(S):
The safe minimum amount of remnant liver after extensive hepatectomy remains unclear. We aimed to determine the impact of future liver remnant (FLR) volume on outcomes.
METHODS:
301 patients who underwent extended right hepatectomy during 1993-2008 were analyzed. FLR volumetry was performed preoperatively and accounted for partial resection of segment IV. Liver insufficiency was defined as postoperative peak serum bilirubin >7 mg/dl. Predictors of liver insufficiency were identified by multivariate analysis.
RESULTS:
Overall morbidity and 90-day mortality were 40% and 6%, respectively. Postoperative liver insufficiency occurred in 45 patients (15%), and liver failure accounted for 61% of perioperative deaths. Among 290 patients who underwent liver volumetry, FLR was <20% in 38, 20.1%-30% in 144, and >30% in 108. Rates of postoperative liver insufficiency and death from liver failure were similar between patients with FLR 20.1%-30% and >30% but higher in patients with FLR ≤20% (figure). Postoperative outcomes were similar with FLR increase from ≤20% to >20% after portal vein embolization (PVE) and with initial FLR >20%. In multivariate analysis body mass index >25 kg/m2, intraoperative blood transfusion, and FLR ≤20% (odds ratio=3.18; 95% CI=1.34-7.54) independently predicted postoperative liver insufficiency.
CONCLUSIONS:
FLR volumetry is important in the selection of patients for PVE and extended right hepatectomy. FLR >20% is sufficient for safe hepatic resection, and FLR 20.1%-30% is not an indication for preoperative PVE.


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