LIVER

The value of residual liver volume as a predictor of hepatic dysfunction and infection after major liver resection

M J Schindl¹, D N Redhead², K C H Fearon¹, O J Garden¹, S J Wigmore¹ on behalf of the Edinburgh Liver Surgery and Transplantation Experimental Research Group (eLISTER)

¹ Department of Clinical and Surgical Sciences (Surgery), Division of Hepatobiliary Surgery, Royal Infirmary Edinburgh, UK
² Department of Radiology, Royal Infirmary Edinburgh, UK

Correspondence to:
Correspondence to:
MrS J Wigmore
Department of Clinical and Surgical Sciences (Surgery), Royal Infirmary Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, UK; s.wigmore{at}ed.ac.uk

Background and aims: Major liver resection incurs a risk of postoperative liver dysfunction and infection and there is a lack of objective evidence relating residual liver volume to these complications.

Patients and methods: Liver volumetry was performed on computer models derived from computed tomography (CT) angioportograms of 104 patients with normal synthetic liver function scheduled for liver resection. Relative residual liver volume (%RLV) was calculated as the relation of residual to total functional liver volume and related to postoperative hepatic dysfunction and infection. Receiver operator characteristic curve analysis was undertaken to determine the critical %RLV predicting severe hepatic dysfunction and infection. Univariate analysis and multivariate logistic regression analysis were performed to delineate perioperative predictors of severe hepatic dysfunction and infection.

Results: The incidence of severe hepatic dysfunction and infection following liver resection increased significantly with smaller %RLV. A critical %RLV of 26.6% was identified as associated with severe hepatic dysfunction (p<0.0001). Additionally, body mass index (BMI), operating time, and intraoperative blood loss were significant prognostic indicators for severe hepatic dysfunction. It was not possible to predict the individual risk of postoperative infection precisely by %RLV. However, in patients undergoing major liver resection, infection was significantly more common in those who developed postoperative severe hepatic dysfunction compared with those who did not (p = 0.030).

Conclusions: The likelihood of severe hepatic dysfunction following liver resection can be predicted by a small %RLV and a high BMI whereas postoperative infection is more related to liver dysfunction than precise residual liver volume. Understanding the relationship between liver volume and synthetic and immune function is the key to improving the safety of major liver resection.

Abbreviations: CT, computed tomography; CTAP, CT angioportography; BMI, body mass index; ROC, receiver operator characteristic; TLV, total liver volume; TuV, tumour volume; TFLV, total functional liver volume; RLV, residual liver volume; %RLV, relative residual liver volume

Keywords: image analysis; innate immunity; liver function; liver surgery

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