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. 2008 Jun;25(2):104-9.
doi: 10.1055/s-2008-1076681.

Standardized liver volumetry for portal vein embolization

Dario Ribero  1 , Yun Shin Chun, Jean-Nicolas Vauthey
Affiliations

Standardized liver volumetry for portal vein embolization

Dario Ribero et al. Semin Intervent Radiol. 2008 Jun.

Abstract

Major and extended hepatic resections are being performed with increasing frequency as morbidity and mortality rates after major hepatectomies have declined and definitions of resectability have expanded for primary and metastatic hepatic malignancies. Systematic assessment of the anticipated functional remnant liver is essential before major hepatic resection to avoid postoperative hepatic insufficiency and its attendant sequelae. The volume of the future liver remnant (FLR) correlates with FLR function and postoperative outcome. This article describes the rationale for FLR measurement, methods of measuring FLR volume, and standardization to the total estimated liver volume. The indications for portal vein embolization based on standardized liver volumetry are summarized.

Keywords: Liver volumetry; future liver remnant; portal vein embolization.

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Figures

Figure 1
Figure 1
Variability in volume contributions of the right liver, left liver, and bisegment II/III based on computed tomography volumetry in 102 patients. TLV, total liver volume. (Adapted with permission from Abdalla EK, Denys A, Chevalier P, Nemr RA, Vauthey JN. Total and segmental liver volume variations: implications for liver surgery. Surgery 2004;135:404–410. © Elsevier 2004.)
Figure 2
Figure 2
Standardized future liver remnant (sFLR) measurement before and after portal vein embolization (PVE). (A) The future liver remnant (FLR) volume, represented by bisegment II/III in this patient, is measured directly with computed tomography and standardized to the total estimated liver volume (TELV), which is calculated from the formula − 794 + 1267 × BSA (body surface area). The FLR-to-TELV ratio is measured before (B) and after (C) PVE to assess the degree of hypertrophy. (Parts B and C adapted with permission from Vauthey JN, Madoff DC, Abdalla EK. Preoperative portal vein embolization: a Western perspective. In: Blumgart LH, ed. Surgery of the Liver and Biliary Tract. 4th ed. Vol. 2. Philadelphia: Elsevier; 2007:1461–1469.)
Figure 3
Figure 3
Correlation between body surface area (BSA) and total liver volume (TLV) in 292 Western patients. (—) 95% confidence interval and (…) 95% predictive interval. (Reprinted with permission from Vauthey JN, Abdalla EK, Doherty DA, et al. Body surface area and body weight predict total liver volume in Western adults. Liver Transpl 2002;8:233–240.)
Figure 4
Figure 4
Guidelines for minimum standardized future liver remnants before hepatic resection according to underlying liver condition. (Reprinted with permission from Zorzi D, Laurent A, Pawlik TM, Lauwers GY, Vauthey JN, Abdalla EK. Chemotherapy-associated hepatotoxicity and surgery for colorectal liver metastases. Br J Surg 2007;94:274–286. © British Journal of Surgery Society Ltd. Reproduced with permission. Permission is granted by John Wiley & Sons Ltd on behalf of the BJSS Ltd.)
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