Impact of future liver remnant volume on the outcome of major hepatectomy for hepatocellular carcinoma

Abstract

Background: Hepatic resection is used increasingly for the management of a variety of benign and malignant conditions, yet the resulting small functional remnant liver volumes and compromised liver function increase the risk for the development of posthepatectomy liver failure (PHLF). In spite of the assistance with the functional and imaging measures to assess preoperatively the size and function of the future liver remnant, and also the use of portal vein embolization as a preventive intervention, PHLF remains a major concern and has been shown to be a predominant cause of hepatectomy-related mortality.

Objective: To investigate the impact of future liver remnant volume on the outcome of major hepatectomy for hepatocellular carcinoma.

Patients and Methods: The study period was from Jan 2000 – Dec 2014. Selection criteria was patient undergoing major hepatectomy with CT volumetry performed. For those with PVE done, only the pre-PVE volume was considered for analysis. 204 patients are recruited in the study, all patients with HCC who had volumetry done before hepactectomy.

Results: None of the patients with preoperative sFLR less than or equals to 25% has multi-organ failure while there are 4% and 3.6% patients with preoperative sFLR from 25.1% to 35% and more than 35% respectively have multi-organ failure. 11.8%, 1.3% and 4.5% patients with preoperative sFLR less than or equals to 25%, from 25.1% to 35% and more than 35% respectively died during the stay in the hospital after the operation.

Conclusions: Although there are no statistical differences between the three groups in postoperative complications, liver failure and and hospital mortality, the hospital mortality for FLR less than 25% is still higher (11.8%) than the other two groups.