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Multicenter Study
. 2015 Dec;17(12):1051-7.
doi: 10.1111/hpb.12480. Epub 2015 Sep 16.

Comparison of techniques for volumetric analysis of the future liver remnant: implications for major hepatic resections

Guillaume Martel  1 , Kasia P Cieslak  2 , Ruiyao Huang  1 , Krijn P van Lienden  3 , Jimme K Wiggers  2 , Assia Belblidia  4 , Michel Dagenais  1 , Réal Lapointe  1 , Thomas M van Gulik  2 , Franck Vandenbroucke-Menu  1
Affiliations
Multicenter Study

Comparison of techniques for volumetric analysis of the future liver remnant: implications for major hepatic resections

Guillaume Martel et al. HPB (Oxford). 2015 Dec.

Abstract

Objective: The purpose of this work was to compare measured and estimated volumetry prior to liver resection.

Methods: Data for consecutive patients submitted to major liver resection for colorectal liver metastases at two centres during 2004-2012 were reviewed. All patients underwent volumetric analysis to define the measured total liver volume (mTLV) and measured future liver remnant ratio (mR(FLR)). The estimated total liver volume (eTLV) standardized to body surface area and estimated future liver remnant ratio (eR(FLR)) were calculated. Descriptive statistics were generated and compared. A difference between mR(FLR) and eR(FLR) of ±5% was considered clinically relevant.

Results: Data for a total of 116 patients were included. All patients underwent major resection and 51% underwent portal vein embolization. The mean difference between mTLV and eTLV was 157 ml (P < 0.0001), whereas the mean difference between mR(FLR) and eR(FLR) was -1.7% (P = 0.013). By linear regression, eTLV was only moderately predictive of mTLV (R(2) = 0.35). The distribution of differences between mR(FLR) and eR(FLR) demonstrated that the formula over- or underestimated mR(FLR) by ≥5% in 31.9% of patients.

Conclusions: Measured and estimated volumetry yielded differences in the FLR of ≥5% in almost one-third of patients, potentially affecting clinical decision making. Estimated volumetry should be used cautiously and cannot be recommended for general use.

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Figures

Figure 1
Figure 1
Agreement between measured and estimated total liver volume (TLV) in 116 patients submitted to major liver resection for colorectal liver metastases
Figure 2
Figure 2
Agreement between the measured and estimated future liver remnant (FLR) ratio in 116 patients submitted to major liver resection for colorectal liver metastases
Figure 3
Figure 3
Distribution of paired differences in the future liver remnant (FLR) between measurement techniques
See this image and copyright information in PMC

Comment in

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