Volumetric analysis predicts hepatic dysfunction in patients undergoing major liver resection Journal Article

Authors: Shoup, M.; Gonen, M.; D'Angelica, M.; Jarnagin, W. R.; DeMatteo, R. P.; Schwartz, L. H.; Tuorto, S.; Blumgart, L. H.; Fong, Y.
Article Title: Volumetric analysis predicts hepatic dysfunction in patients undergoing major liver resection
Abstract: Liver-enhancing modalities, such as portal vein embolization, are increasingly employed prior to major liver resection to prevent postoperative liver dysfunction. Selection criteria for such techniques are not well described. This study uses CT-based volumetric analysis as a tool to identify patients at highest risk for postoperative hepatic dysfunction. Between July 1999 and December 2000, a total of 126 consecutive patients who were undergoing liver resection for colorectal metastasis and had CT scans at our institution were included in the analysis. Volume of resection was determined by semiautomated contouring of the liver on preoperative volumetrically (helical) acquired CT scans. Hepatic dysfunction was defined as prothrombin time greater than 18 seconds or serum bilirubin level greater than 3 mg/dl. Marginal regression was used to compare the predictive ability of volumetric analysis and the extent of resection. The percentage of liver remaining was closely correlated with increasing prothrombin time and bilirubin level (P < 0.001). After trisegmentectomy, 90% of patients with ≤25% of liver remaining developed hepatic dysfunction, compared with none of the patients with more than 25% of liver remaining after trisegmentectomy (P < 0.0001). The percentage of liver remaining was more specific in predicting hepatic dysfunction than was the anatomic extent of resection (P = 0.003). Male sex nearly doubled the risk of hepatic dysfunction (odds ratio = 1.89, P = 0.027), and having ≤25% of liver remaining more than tripled the risk (odds ratio = 3.09, P < 0.0001). Hepatic dysfunction and ≤25% of liver remaining were associated with increased complications and length of hospital stay (P < 0.0001 and P = 0.0003, respectively). Preoperative assessment of future liver volume remaining distinguishes which patients undergoing liver resection will most likely benefit from preoperative liver enhancement techniques such as portal vein embolization. © 2003 The Society for Surgery of the Alimentary Tract, Inc.
Keywords: adult; controlled study; aged; aged, 80 and over; middle aged; retrospective studies; major clinical study; postoperative period; artificial embolism; liver neoplasms; liver dysfunction; pathophysiology; preoperative evaluation; colorectal cancer; metastasis; computer assisted tomography; pathology; retrospective study; prediction; risk factor; sex ratio; high risk patient; postoperative complication; colorectal neoplasms; tomography, spiral computed; bilirubin; prothrombin time; length of stay; liver; colorectal tumor; liver tumor; prediction and forecasting; predictive value of tests; liver resection; hepatectomy; radiography; sex difference; liver function test; bilirubin blood level; volumetry; liver function tests; spiral computer assisted tomography; humans; human; male; female; article; hepatic dysfunction
Journal Title: Journal of Gastrointestinal Surgery
Volume: 7
Issue: 3
ISSN: 1091-255X
Publisher: Springer  
Date Published: 2003-03-01
Start Page: 325
End Page: 330
Language: English
DOI: 10.1016/s1091-255x(02)00370-0
PUBMED: 12654556
PROVIDER: scopus
Notes: Export Date: 12 September 2014 -- Source: Scopus
Citation Impact
MSK Authors
  1. Leslie H Blumgart
    350 Blumgart
  2. Ronald P DeMatteo
    627 DeMatteo
  3. Mithat Gonen
    780 Gonen
  4. Margaret Shoup
    20 Shoup
  5. Lawrence H Schwartz
    282 Schwartz
  6. William R Jarnagin
    645 Jarnagin
  7. Yuman Fong
    772 Fong
  8. Scott J Tuorto
    23 Tuorto