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BACKGROUND: Before extended hepatectomy of five or more segments, the remnant liver volume (RLV) is usually calculated as a ratio of RLV to total liver volume (RLV-TLV) and must be >20% to 25%. This method can lead to compare parts of normal liver parenchyma to others compromised by biliary or vascular obstruction or by portal vein embolization. Extrapolating from living-donor liver transplantation, we hypothesized that RLV to body weight ratio (RLV-BWR) could accurately assess the functional limit of hepatectomy. STUDY DESIGN: From September 2000 to December 2004, volumetric measurements of RLV using computed tomography were obtained before right-extended hepatectomy in 31 patients. RLV-BWR of 0.5% as a critical point for patient course was compared with stratification by RLV-TLV (25% and 20%). RESULTS: Three-month morbidity and mortality were not significantly different between groups RLV-TLV 25% and between groups RLV-TLV 20%, but increased significantly in group RLV-BWR 0.5% (p = 0.038 and p = 0.019, respectively) with an non-significant increase in death from liver failure (p = 0.077). CONCLUSIONS: RLV-BWR was more specific than RLV-TLV in predicting postoperative course after extended hepatectomy. Patients with an anticipated RLV < or = 0.5% of body weight are at considerable risk for hepatic dysfunction and postoperative mortality.
Truant et al. (Fri,) studied this question.