OBJECTIVES: The actual future liver remnant (aFLR) is calculated as the ratio of remnant liver volume (RLV) to total functional liver volume (TFLV). The standardized future liver remnant (sFLR) is calculated as the ratio of RLV to standard liver volume (SLV). The aims of this study were to compare the aFLR with the sFLR and to determine criteria for safe hepatectomy using computed tomography volumetry and indocyanine green retention rate at 15 min (ICG R15). METHODS: Medical records and volumetric measurements were obtained retrospectively for 81 patients who underwent right hemi-hepatectomy for malignant hepatic tumours from January 2010 to November 2013. The sFLR was compared with the aFLR, and a ratio of sFLR to ICG R15 as a predictor of postoperative hepatic function was established. RESULTS: In patients without cirrhosis, the sFLR showed a stronger correlation with the total serum bilirubin level than the aFLR (R(2) = 0.499 versus R(2) = 0.239). Post-hepatectomy liver failure developed only in the group with an sFLR of <25%, regardless of ICG R15. In patients with cirrhosis, the aFLR and sFLR had no correlation with postoperative total serum bilirubin. An sFLR : ICG R15 ratio of >1.9 showed 66.7% sensitivity and 100% specificity. CONCLUSIONS: Regardless of ICG R15, an sFLR of ≥ 25% in patients without cirrhosis, and an sFLR of ≥ 25% with an sFLR : ICG R15 ratio of >1.9 in patients with cirrhosis indicate acceptable levels of safety in major hepatectomy.
OBJECTIVES: The actual future liver remnant (aFLR) is calculated as the ratio of remnant liver volume (RLV) to total functional liver volume (TFLV). The standardized future liver remnant (sFLR) is calculated as the ratio of RLV to standard liver volume (SLV). The aims of this study were to compare the aFLR with the sFLR and to determine criteria for safe hepatectomy using computed tomography volumetry and indocyanine green retention rate at 15 min (ICG R15). METHODS: Medical records and volumetric measurements were obtained retrospectively for 81 patients who underwent right hemi-hepatectomy for malignant hepatic tumours from January 2010 to November 2013. The sFLR was compared with the aFLR, and a ratio of sFLR to ICG R15 as a predictor of postoperative hepatic function was established. RESULTS: In patients without cirrhosis, the sFLR showed a stronger correlation with the total serum bilirubin level than the aFLR (R(2) = 0.499 versus R(2) = 0.239). Post-hepatectomy liver failure developed only in the group with an sFLR of <25%, regardless of ICG R15. In patients with cirrhosis, the aFLR and sFLR had no correlation with postoperative total serum bilirubin. An sFLR : ICG R15 ratio of >1.9 showed 66.7% sensitivity and 100% specificity. CONCLUSIONS: Regardless of ICG R15, an sFLR of ≥ 25% in patients without cirrhosis, and an sFLR of ≥ 25% with an sFLR : ICG R15 ratio of >1.9 in patients with cirrhosis indicate acceptable levels of safety in major hepatectomy.
Authors: J N Vauthey; A Chaoui; K A Do; M M Bilimoria; M J Fenstermacher; C Charnsangavej; M Hicks; G Alsfasser; G Lauwers; I F Hawkins; J Caridi Journal: Surgery Date: 2000-05 Impact factor: 3.982
Authors: Nuh N Rahbari; O James Garden; Robert Padbury; Mark Brooke-Smith; Michael Crawford; Rene Adam; Moritz Koch; Masatoshi Makuuchi; Ronald P Dematteo; Christopher Christophi; Simon Banting; Val Usatoff; Masato Nagino; Guy Maddern; Thomas J Hugh; Jean-Nicolas Vauthey; Paul Greig; Myrddin Rees; Yukihiro Yokoyama; Sheung Tat Fan; Yuji Nimura; Joan Figueras; Lorenzo Capussotti; Markus W Büchler; Jürgen Weitz Journal: Surgery Date: 2011-01-14 Impact factor: 3.982
Authors: Yoji Kishi; Eddie K Abdalla; Yun Shin Chun; Daria Zorzi; David C Madoff; Michael J Wallace; Steven A Curley; Jean-Nicolas Vauthey Journal: Ann Surg Date: 2009-10 Impact factor: 12.969
Authors: Margo Shoup; Mithat Gonen; Michael D'Angelica; William R Jarnagin; Ronald P DeMatteo; Lawrence H Schwartz; Scott Tuorto; Leslie H Blumgart; Yuman Fong Journal: J Gastrointest Surg Date: 2003 Mar-Apr Impact factor: 3.452
Authors: Martin Zeile; Artur Bakal; Jan E Volkmer; Gregor A Stavrou; Philip Dautel; Jan Hoeltje; Axel Stang; Karl J Oldhafer; Roland Brüning Journal: Br J Radiol Date: 2016-10-12 Impact factor: 3.039
Authors: Linda M Pak; Jayasree Chakraborty; Mithat Gonen; William C Chapman; Richard K G Do; Bas Groot Koerkamp; Kees Verhoef; Ser Yee Lee; Marco Massani; Eric P van der Stok; Amber L Simpson Journal: J Am Coll Surg Date: 2018-02-15 Impact factor: 6.113
Authors: Dongbo Wu; Enqiang Chen; Tao Liang; Menglan Wang; Bin Chen; Bai Lang; Hong Tang Journal: Medicine (Baltimore) Date: 2017-08 Impact factor: 1.889