Prediction of postoperative liver failure and evaluation of modifi ed　criteria for liver resection with computed volume analysis

Background/Aims: The exact resectable volume corresponding to liver function has never been elucidated for safe resection of a diseased liver. The aim of this study was to evaluate whether modifi ed criteria for safe liver resection could be used to predict postoperative liver failure/dysfunction.Methodology: Consecutive 86 patients who underwent liver resections were assessed. Clinical laboratory tests and liver volume were evaluated. The modifi ed criteria used to determine safe liver resection consisted of indocyanine green retention rate at 15 min (ICGR15), antithrombin III (ATIII), clearance index (HH15), and receptor index (LHL15). We compared clinical outcomes after liver resection using our modifi ed criteria and Makuuchi criteria. Results: There were 78 patients without liver failure and 8 with liver failure/dysfunction. ICGR15 (P < 0.001), ATIII (P = 0.036), operative time (P = 0.014), tumor type (P = 0.047), modifi ed criteria score (P = 0.037), lost liver volume (P = 0.006), and modifi ed criteria (P= 0.007) were signifi cantly different between the groups. Diagnostic probability of modifi ed criteria (P = 0.007) was better than the one of Makuuchi criteria (P = 0.271).Conclusions: Postoperative liver failure/dysfunction could be predicted using the modifi ed criteria. Furthermore, the criteria could be used to provide a putative liver volume for safe removal.