Assessment and optimization of liver volume before major hepatic resection: Current guidelines and a narrative review

Int J Surg. 2018 Apr:52:74-81. doi: 10.1016/j.ijsu.2018.01.042. Epub 2018 Feb 7.

Abstract

Post hepatectomy liver failure (PHLF) remains a significant cause of morbidity and mortality after major liver resection. Although the etiology of PHLF is multifactorial, an inadequate functional liver remnant (FLR) is felt to be the most important modifiable predictor of PHLF. Pre-operative evaluation of FLR function and volume is of paramount importance before proceeding with any major liver resection. Patients with inadequate or borderline FLR volume must be considered for volume optimization strategies such as portal vein embolization (PVE), two stage hepatectomy with portal vein ligation (PVL), Yttrium-90 radioembolization, and associating liver partition and portal vein ligation for staged hepatectomy (ALPPS). This paper provides an overview of assessing FLR volume and function, and discusses indications and outcomes of commonly used volume optimization strategies.

Keywords: ALLPS; Associating liver partition and portal vein ligation; Extended hepatectomy; Functional liver volume; Future liver remnant; Liver volume optimization; Portal vein embolization; Portal vein ligation; Two stage hepatectomy.

Publication types

  • Review

MeSH terms

  • Embolization, Therapeutic / adverse effects
  • Embolization, Therapeutic / methods
  • Female
  • Hepatectomy / adverse effects*
  • Humans
  • Ligation / adverse effects
  • Ligation / methods
  • Liver / physiopathology*
  • Liver / surgery
  • Liver Failure / etiology*
  • Liver Regeneration
  • Male
  • Portal Vein / surgery
  • Practice Guidelines as Topic
  • Preoperative Care / methods
  • Risk Factors
  • Treatment Outcome
  • Vascular Surgical Procedures / adverse effects