Three hundred and one consecutive extended right hepatectomies: evaluation of outcome based on systematic liver volumetry
This study aimed to determine the effect of preoperative liver volumetry on postoperative outcomes after extended right hepatectomy. Primary end point was to evaluate whether future liver remnant (FLR)/standardized liver volume ratio (sFLR) >20% is sufficient for a safe hepatic resection. Seconda...
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| Veröffentlicht in: | Annals of surgery 2009-10, Vol.250 (4), p.540-548 |
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| creator | Kishi, Yoji Abdalla, Eddie K Chun, Yun Shin Zorzi, Daria Madoff, David C Wallace, Michael J Curley, Steven A Vauthey, Jean-Nicolas |
| description | This study aimed to determine the effect of preoperative liver volumetry on postoperative outcomes after extended right hepatectomy. Primary end point was to evaluate whether future liver remnant (FLR)/standardized liver volume ratio (sFLR) >20% is sufficient for a safe hepatic resection. Secondary end point was to assess whether preoperative portal vein embolization (PVE) is associated with improved outcome in patients with initial sFLR ≤ 20%.
An sFLR >20% of the total liver volume has been proposed as sufficient for safe hepatic resection, but this concept has not been validated in a large series. In addition, recent reports suggest preoperative PVE is indicated for sFLR 7 mg/dL. Predictors of liver insufficiency were identified by multivariate logistic regression.
Postoperative liver insufficiency occurred in 45 patients (15%) and accounted for 61% of deaths. Among 290 patients who underwent liver volumetry, sFLR was 20% after PVE and patients with initial sFLR >20%. Multivariate analysis revealed that body mass index >25 kg/m2, intraoperative blood transfusion, and sFLR ≤ 20% (odds ratio = 3.18; 95% CI, 1.34-7.54) independently predicted postoperative liver insufficiency.
Systematic measurement of FLR volume is important to select patients for PVE and extended right hepatectomy. A sFLR >20% is sufficient for safe hepatic resection and sFLR 20.1% to 30% is not an indication for preoperative PVE. |
| doi_str_mv | 10.1097/SLA.0b013e3181b674df |
| format | Article |
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An sFLR >20% of the total liver volume has been proposed as sufficient for safe hepatic resection, but this concept has not been validated in a large series. In addition, recent reports suggest preoperative PVE is indicated for sFLR <30%.
The impact of sFLR and PVE on short-term outcomes (postoperative complications, liver insufficiency, and 90-day mortality) was analyzed in 301 consecutive patients after extended right hepatectomy. Liver volumetry accounted for partial resection of segment IV. Liver insufficiency was defined as peak postoperative serum bilirubin >7 mg/dL. Predictors of liver insufficiency were identified by multivariate logistic regression.
Postoperative liver insufficiency occurred in 45 patients (15%) and accounted for 61% of deaths. Among 290 patients who underwent liver volumetry, sFLR was <20% in 38 patients, 20.1% to 30% in 144, and ≥ 30% in 108. Rates of postoperative liver insufficiency and death from liver failure were similar between patients with sFLR 20.1% to 30% and sFLR ≥ 30% but higher in patients with sFLR ≤ 20% (P 0.05). Postoperative outcomes were similar between patients with increase in sFLR from ≤ 20% to >20% after PVE and patients with initial sFLR >20%. Multivariate analysis revealed that body mass index >25 kg/m2, intraoperative blood transfusion, and sFLR ≤ 20% (odds ratio = 3.18; 95% CI, 1.34-7.54) independently predicted postoperative liver insufficiency.
Systematic measurement of FLR volume is important to select patients for PVE and extended right hepatectomy. A sFLR >20% is sufficient for safe hepatic resection and sFLR 20.1% to 30% is not an indication for preoperative PVE.</description><identifier>ISSN: 0003-4932</identifier><identifier>EISSN: 1528-1140</identifier><identifier>DOI: 10.1097/SLA.0b013e3181b674df</identifier><identifier>PMID: 19730239</identifier><language>eng</language><publisher>United States</publisher><subject>Adolescent ; Adult ; Aged ; Aged, 80 and over ; Bilirubin - blood ; Chi-Square Distribution ; Child ; Embolization, Therapeutic ; Endpoint Determination ; Female ; Hepatectomy - methods ; Hepatectomy - mortality ; Humans ; Liver - anatomy & histology ; Liver - surgery ; Liver Function Tests ; Logistic Models ; Male ; Middle Aged ; Outcome and Process Assessment, Health Care ; Patient Selection ; Portal Vein ; Postoperative Complications - mortality ; Preoperative Care ; Retrospective Studies ; Risk Factors ; Statistics, Nonparametric</subject><ispartof>Annals of surgery, 2009-10, Vol.250 (4), p.540-548</ispartof><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c255t-ae7f900d000c9a0784db140b9c5485bcc752a6e2cfca8770454cc45eb13e87863</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19730239$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kishi, Yoji</creatorcontrib><creatorcontrib>Abdalla, Eddie K</creatorcontrib><creatorcontrib>Chun, Yun Shin</creatorcontrib><creatorcontrib>Zorzi, Daria</creatorcontrib><creatorcontrib>Madoff, David C</creatorcontrib><creatorcontrib>Wallace, Michael J</creatorcontrib><creatorcontrib>Curley, Steven A</creatorcontrib><creatorcontrib>Vauthey, Jean-Nicolas</creatorcontrib><title>Three hundred and one consecutive extended right hepatectomies: evaluation of outcome based on systematic liver volumetry</title><title>Annals of surgery</title><addtitle>Ann Surg</addtitle><description>This study aimed to determine the effect of preoperative liver volumetry on postoperative outcomes after extended right hepatectomy. Primary end point was to evaluate whether future liver remnant (FLR)/standardized liver volume ratio (sFLR) >20% is sufficient for a safe hepatic resection. Secondary end point was to assess whether preoperative portal vein embolization (PVE) is associated with improved outcome in patients with initial sFLR ≤ 20%.
An sFLR >20% of the total liver volume has been proposed as sufficient for safe hepatic resection, but this concept has not been validated in a large series. In addition, recent reports suggest preoperative PVE is indicated for sFLR <30%.
The impact of sFLR and PVE on short-term outcomes (postoperative complications, liver insufficiency, and 90-day mortality) was analyzed in 301 consecutive patients after extended right hepatectomy. Liver volumetry accounted for partial resection of segment IV. Liver insufficiency was defined as peak postoperative serum bilirubin >7 mg/dL. Predictors of liver insufficiency were identified by multivariate logistic regression.
Postoperative liver insufficiency occurred in 45 patients (15%) and accounted for 61% of deaths. Among 290 patients who underwent liver volumetry, sFLR was <20% in 38 patients, 20.1% to 30% in 144, and ≥ 30% in 108. Rates of postoperative liver insufficiency and death from liver failure were similar between patients with sFLR 20.1% to 30% and sFLR ≥ 30% but higher in patients with sFLR ≤ 20% (P 0.05). Postoperative outcomes were similar between patients with increase in sFLR from ≤ 20% to >20% after PVE and patients with initial sFLR >20%. Multivariate analysis revealed that body mass index >25 kg/m2, intraoperative blood transfusion, and sFLR ≤ 20% (odds ratio = 3.18; 95% CI, 1.34-7.54) independently predicted postoperative liver insufficiency.
Systematic measurement of FLR volume is important to select patients for PVE and extended right hepatectomy. A sFLR >20% is sufficient for safe hepatic resection and sFLR 20.1% to 30% is not an indication for preoperative PVE.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Bilirubin - blood</subject><subject>Chi-Square Distribution</subject><subject>Child</subject><subject>Embolization, Therapeutic</subject><subject>Endpoint Determination</subject><subject>Female</subject><subject>Hepatectomy - methods</subject><subject>Hepatectomy - mortality</subject><subject>Humans</subject><subject>Liver - anatomy & histology</subject><subject>Liver - surgery</subject><subject>Liver Function Tests</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Outcome and Process Assessment, Health Care</subject><subject>Patient Selection</subject><subject>Portal Vein</subject><subject>Postoperative Complications - mortality</subject><subject>Preoperative Care</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Statistics, Nonparametric</subject><issn>0003-4932</issn><issn>1528-1140</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkMtKw0AUhgdRbK2-gcjsXEXPZCadxF0p3qDgwroOk8mJjSSZOpdi3t4pLQiuzuK_HP6PkGsGdwwKef--WtxBBYwjZzmr5lLUzQmZsizNE8YEnJIpAPBEFDydkAvnvgCYyEGekwkrJIeUF1MyrjcWkW7CUFusqRpqagak2gwOdfDtDin-eBzqKNr2c-PpBrfKo_amb9E9UNypLijfmoGahprgtemRVsrhvom60Xnso65pF8ss3Zku9OjteEnOGtU5vDreGfl4elwvX5LV2_PrcrFKdJplPlEomwKgjlt0oUDmoq7iuqrQmcizSmuZpWqOqW60yqUEkQmtRYZVBJPLfM5n5PbQu7XmO6DzZd86jV2nBjTBldEiOGdy7xQHp7bGOYtNubVtr-xYMij3zMvIvPzPPMZujg9C1WP9FzpC5r80Z4E6</recordid><startdate>200910</startdate><enddate>200910</enddate><creator>Kishi, Yoji</creator><creator>Abdalla, Eddie K</creator><creator>Chun, Yun Shin</creator><creator>Zorzi, Daria</creator><creator>Madoff, David C</creator><creator>Wallace, Michael J</creator><creator>Curley, Steven A</creator><creator>Vauthey, Jean-Nicolas</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>200910</creationdate><title>Three hundred and one consecutive extended right hepatectomies: evaluation of outcome based on systematic liver volumetry</title><author>Kishi, Yoji ; Abdalla, Eddie K ; Chun, Yun Shin ; Zorzi, Daria ; Madoff, David C ; Wallace, Michael J ; Curley, Steven A ; Vauthey, Jean-Nicolas</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c255t-ae7f900d000c9a0784db140b9c5485bcc752a6e2cfca8770454cc45eb13e87863</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2009</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Bilirubin - blood</topic><topic>Chi-Square Distribution</topic><topic>Child</topic><topic>Embolization, Therapeutic</topic><topic>Endpoint Determination</topic><topic>Female</topic><topic>Hepatectomy - methods</topic><topic>Hepatectomy - mortality</topic><topic>Humans</topic><topic>Liver - anatomy & histology</topic><topic>Liver - surgery</topic><topic>Liver Function Tests</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Outcome and Process Assessment, Health Care</topic><topic>Patient Selection</topic><topic>Portal Vein</topic><topic>Postoperative Complications - mortality</topic><topic>Preoperative Care</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Statistics, Nonparametric</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kishi, Yoji</creatorcontrib><creatorcontrib>Abdalla, Eddie K</creatorcontrib><creatorcontrib>Chun, Yun Shin</creatorcontrib><creatorcontrib>Zorzi, Daria</creatorcontrib><creatorcontrib>Madoff, David C</creatorcontrib><creatorcontrib>Wallace, Michael J</creatorcontrib><creatorcontrib>Curley, Steven A</creatorcontrib><creatorcontrib>Vauthey, Jean-Nicolas</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Annals of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kishi, Yoji</au><au>Abdalla, Eddie K</au><au>Chun, Yun Shin</au><au>Zorzi, Daria</au><au>Madoff, David C</au><au>Wallace, Michael J</au><au>Curley, Steven A</au><au>Vauthey, Jean-Nicolas</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Three hundred and one consecutive extended right hepatectomies: evaluation of outcome based on systematic liver volumetry</atitle><jtitle>Annals of surgery</jtitle><addtitle>Ann Surg</addtitle><date>2009-10</date><risdate>2009</risdate><volume>250</volume><issue>4</issue><spage>540</spage><epage>548</epage><pages>540-548</pages><issn>0003-4932</issn><eissn>1528-1140</eissn><abstract>This study aimed to determine the effect of preoperative liver volumetry on postoperative outcomes after extended right hepatectomy. Primary end point was to evaluate whether future liver remnant (FLR)/standardized liver volume ratio (sFLR) >20% is sufficient for a safe hepatic resection. Secondary end point was to assess whether preoperative portal vein embolization (PVE) is associated with improved outcome in patients with initial sFLR ≤ 20%.
An sFLR >20% of the total liver volume has been proposed as sufficient for safe hepatic resection, but this concept has not been validated in a large series. In addition, recent reports suggest preoperative PVE is indicated for sFLR <30%.
The impact of sFLR and PVE on short-term outcomes (postoperative complications, liver insufficiency, and 90-day mortality) was analyzed in 301 consecutive patients after extended right hepatectomy. Liver volumetry accounted for partial resection of segment IV. Liver insufficiency was defined as peak postoperative serum bilirubin >7 mg/dL. Predictors of liver insufficiency were identified by multivariate logistic regression.
Postoperative liver insufficiency occurred in 45 patients (15%) and accounted for 61% of deaths. Among 290 patients who underwent liver volumetry, sFLR was <20% in 38 patients, 20.1% to 30% in 144, and ≥ 30% in 108. Rates of postoperative liver insufficiency and death from liver failure were similar between patients with sFLR 20.1% to 30% and sFLR ≥ 30% but higher in patients with sFLR ≤ 20% (P 0.05). Postoperative outcomes were similar between patients with increase in sFLR from ≤ 20% to >20% after PVE and patients with initial sFLR >20%. Multivariate analysis revealed that body mass index >25 kg/m2, intraoperative blood transfusion, and sFLR ≤ 20% (odds ratio = 3.18; 95% CI, 1.34-7.54) independently predicted postoperative liver insufficiency.
Systematic measurement of FLR volume is important to select patients for PVE and extended right hepatectomy. A sFLR >20% is sufficient for safe hepatic resection and sFLR 20.1% to 30% is not an indication for preoperative PVE.</abstract><cop>United States</cop><pmid>19730239</pmid><doi>10.1097/SLA.0b013e3181b674df</doi><tpages>9</tpages></addata></record> |
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| ispartof | Annals of surgery, 2009-10, Vol.250 (4), p.540-548 |
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| subjects | Adolescent Adult Aged Aged, 80 and over Bilirubin - blood Chi-Square Distribution Child Embolization, Therapeutic Endpoint Determination Female Hepatectomy - methods Hepatectomy - mortality Humans Liver - anatomy & histology Liver - surgery Liver Function Tests Logistic Models Male Middle Aged Outcome and Process Assessment, Health Care Patient Selection Portal Vein Postoperative Complications - mortality Preoperative Care Retrospective Studies Risk Factors Statistics, Nonparametric |
| title | Three hundred and one consecutive extended right hepatectomies: evaluation of outcome based on systematic liver volumetry |
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