Document Detail

Comparison of two methods of future liver remnant volume measurement.
MedLine Citation:
PMID:  17924174     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: In liver transplantation, a minimum graft to patient body weight (BW) ratio is required for graft survival; in liver resection, total liver volume (TLV) calculated from body surface area (BSA) is used to determine the future liver remnant (FLR) volume needed for safe hepatic resection. These two methods of estimating liver volume have not previously been compared. The purpose of this study was to compare FLR volumes standardized to BW versus BSA and to assess their utility in predicting postoperative hepatic dysfunction after hepatic resection. METHODS: Records were reviewed of 68 consecutive noncirrhotic patients who underwent major hepatectomy after portal vein embolization between 1998 and 2006. FLR (cubic centimeter) was measured preoperatively with three-dimensional helical computed tomography; TLV (cubic centimeter) was calculated from the patients' BSA. The relationship between FLR/TLV and FLR/BW (cubic centimeter per kilogram) was examined using linear regression analysis. Receiver operating characteristic (ROC) curve analysis was used to determine FLR/TLV and FLR/BW cutoff values for predicting postoperative hepatic dysfunction (defined as peak bilirubin level>3 mg/dl or prothrombin time>18 s). RESULTS: Regression analysis revealed that the FLR/TLV and FLR/BW ratios were highly correlated (Pearson correlation coefficient, 0.98). The area under the ROC curve was 0.85 for FLR/TLV and 0.84 for FLR/BW (95% confidence interval, 0.71-0.97). Sixteen of the 68 patients developed postoperative hepatic dysfunction. The ROC curve analysis yielded a cutoff FLR/BW value of <or=0.4, which had a positive predictive value (PPV) of 78% and a negative predictive value (NPV) of 85%. The corresponding FLR/TLV cutoff value of <or=20% had a PPV of 80% and a NPV of 86%. CONCLUSIONS: Based on the strong correlation between the FLR measurements standardized to BW and BSA and their similar ability to predict postoperative hepatic dysfunction, both methods are appropriate for assessing liver volume. In noncirrhotic patients, a FLR/BW ratio of <or=0.4 and FLR/TLV of <or=20% provide equivalent thresholds for performing safe hepatic resection.
Yun Shin Chun; Dario Ribero; Eddie K Abdalla; David C Madoff; Melinda M Mortenson; Steven H Wei; Jean-Nicolas Vauthey
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Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2007-10-09
Journal Detail:
Title:  Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract     Volume:  12     ISSN:  1091-255X     ISO Abbreviation:  J. Gastrointest. Surg.     Publication Date:  2008 Jan 
Date Detail:
Created Date:  2008-01-14     Completed Date:  2008-05-20     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9706084     Medline TA:  J Gastrointest Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  123-8     Citation Subset:  IM    
Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 325, Houston, TX 77030, USA.
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MeSH Terms
Body Weight
Follow-Up Studies
Hepatectomy / methods*
Hepatic Insufficiency / radiography,  surgery*
Liver / physiopathology,  radiography*
Liver Function Tests
Liver Transplantation / methods*,  physiology
Middle Aged
Postoperative Complications / prevention & control
ROC Curve
Retrospective Studies
Tomography, Spiral Computed / methods*

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