Semin intervent Radiol 2008; 25(2): 104-109
DOI: 10.1055/s-2008-1076681
© Thieme Medical Publishers

Standardized Liver Volumetry for Portal Vein Embolization

Dario Ribero1 , Yun Shin Chun1 , Jean-Nicolas Vauthey1
  • 1Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
Further Information

Publication History

Publication Date:
30 May 2008 (online)

ABSTRACT

Major and extended hepatic resections are being performed with increasing frequency as morbidity and mortality rates after major hepatectomies have declined and definitions of resectability have expanded for primary and metastatic hepatic malignancies. Systematic assessment of the anticipated functional remnant liver is essential before major hepatic resection to avoid postoperative hepatic insufficiency and its attendant sequelae. The volume of the future liver remnant (FLR) correlates with FLR function and postoperative outcome. This article describes the rationale for FLR measurement, methods of measuring FLR volume, and standardization to the total estimated liver volume. The indications for portal vein embolization based on standardized liver volumetry are summarized.

REFERENCES

  • 1 Vauthey J N, Pawlik T M, Ribero D et al.. Chemotherapy regimen predicts steatohepatitis and an increase in 90-day mortality after surgery for hepatic colorectal metastases.  J Clin Oncol. 2006;  24 2065-2072
  • 2 Pawlik T M, Scoggins C R, Zorzi D et al.. Effect of surgical margin status on survival and site of recurrence after hepatic resection for colorectal metastases.  Ann Surg. 2005;  241 715-722
  • 3 Charnsangavej C, Clary B, Fong Y et al.. Selection of patients for resection of hepatic colorectal metastases: expert consensus statement.  Ann Surg Oncol. 2006;  13 1261-1268
  • 4 Ribero D, Curley S A, Imamura H et al.. Selection for resection of hepatocellular carcinoma and surgical strategy: indications for resection, evaluation of liver function, portal vein embolization, and resection.  Ann Surg Oncol. 2008;  15 986-992
  • 5 Vauthey J N, Pawlik T M, Abdalla E K et al.. Is extended hepatectomy for hepatobiliary malignancy justified?.  Ann Surg. 2004;  239 722-730
  • 6 Jarnagin W R, Gonen M, Fong Y et al.. Improvement in perioperative outcome after hepatic resection: analysis of 1,803 consecutive cases over the past decade.  Ann Surg. 2002;  236 397-406
  • 7 Wei A C, Tung-Ping Poon R, Fan S T, Wong J. Risk factors for perioperative morbidity and mortality after extended hepatectomy for hepatocellular carcinoma.  Br J Surg. 2003;  90 33-41
  • 8 Mullen J T, Ribero D, Reddy S K et al.. Hepatic insufficiency and mortality in 1,059 noncirrhotic patients undergoing major hepatectomy.  J Am Coll Surg. 2007;  204 854-862
  • 9 Belghiti J, Hiramatsu K, Benoist S et al.. Seven hundred forty-seven hepatectomies in the 1990s: an update to evaluate the actual risk of liver resection.  J Am Coll Surg. 2000;  191 38-46
  • 10 Shoup M, Gonen M, D'Angelica M et al.. Volumetric analysis predicts hepatic dysfunction in patients undergoing major liver resection.  J Gastrointest Surg. 2003;  7 325-330
  • 11 Kubota K, Makuuchi M, Kusaka K et al.. Measurement of liver volume and hepatic functional reserve as a guide to decision-making in resectional surgery for hepatic tumors.  Hepatology. 1997;  26 1176-1181
  • 12 Azoulay D, Castaing D, Krissat J et al.. Percutaneous portal vein embolization increases the feasibility and safety of major liver resection for hepatocellular carcinoma in injured liver.  Ann Surg. 2000;  232 665-672
  • 13 Farges O, Belghiti J, Kianmanesh R et al.. Portal vein embolization before right hepatectomy: prospective clinical trial.  Ann Surg. 2003;  237 208-217
  • 14 Ijichi M, Makuuchi M, Imamura H, Takayama T. Portal embolization relieves persistent jaundice after complete biliary drainage.  Surgery. 2001;  130 116-118
  • 15 Hirai I, Kimura W, Fuse A, Suto K, Urayama M. Evaluation of preoperative portal embolization for safe hepatectomy, with special reference to assessment of nonembolized lobe function with 99mTc-GSA SPECT scintigraphy.  Surgery. 2003;  133 495-506
  • 16 Vauthey J N, Chaoui A, Do K A et al.. Standardized measurement of the future liver remnant prior to extended liver resection: methodology and clinical associations.  Surgery. 2000;  127 512-519
  • 17 Abdalla E K, Denys A, Chevalier P, Nemr R A, Vauthey J N. Total and segmental liver volume variations: implications for liver surgery.  Surgery. 2004;  135 404-410
  • 18 Heymsfield S B, Fulenwider T, Nordlinger B et al.. Accurate measurement of liver, kidney, and spleen volume and mass by computerized axial tomography.  Ann Intern Med. 1979;  90 185-187
  • 19 Ogasawara K, Une Y, Nakajima Y, Uchino J. The significance of measuring liver volume using computed tomographic images before and after hepatectomy.  Surg Today. 1995;  25 43-48
  • 20 Henderson J M, Heymsfield S B, Horowitz J, Kutner M H. Measurement of liver and spleen volume by computed tomography: assessment of reproducibility and changes found following a selective distal splenorenal shunt.  Radiology. 1981;  141 525-527
  • 21 Higashiyama H, Yamaguchi T, Mori K et al.. Graft size assessment by preoperative computed tomography in living related partial liver transplantation.  Br J Surg. 1993;  80 489-492
  • 22 Soyer P, Roche A, Elias D, Levesque M. Hepatic metastases from colorectal cancer: influence of hepatic volumetric analysis on surgical decision making.  Radiology. 1992;  184 695-697
  • 23 Madoff D C, Abdalla E K, Vauthey J N. Portal vein embolization in preparation for major hepatic resection: evolution of a new standard of care.  J Vasc Interv Radiol. 2005;  16 779-790
  • 24 Urata K, Kawasaki S, Matsunami H et al.. Calculation of child and adult standard liver volume for liver transplantation.  Hepatology. 1995;  21 1317-1321
  • 25 Shirabe K, Shimada M, Gion T et al.. Postoperative liver failure after major hepatic resection for hepatocellular carcinoma in the modern era with special reference to remnant liver volume.  J Am Coll Surg. 1999;  188 304-309
  • 26 Abdalla E K, Hicks M E, Vauthey J N. Portal vein embolization: rationale, technique and future prospects.  Br J Surg. 2001;  88 165-175
  • 27 Madoff D C, Hicks M E, Vauthey J N et al.. Transhepatic portal vein embolization: anatomy, indications, and technical considerations.  Radiographics. 2002;  22 1063-1076
  • 28 Kawasaki S, Makuuchi M, Matsunami H et al.. Preoperative measurement of segmental liver volume of donors for living related liver transplantation.  Hepatology. 1993;  18 1115-1120
  • 29 Kiuchi T, Kasahara M, Uryuhara K et al.. Impact of graft size mismatching on graft prognosis in liver transplantation from living donors.  Transplantation. 1999;  67 321-327
  • 30 Chun Y S, Ribero D, Abdalla E K et al.. Comparison of two methods of future liver remnant volume measurement.  J Gastrointest Surg. 2008;  12 123-128
  • 31 Heinemann A, Wischhusen F, Puschel K, Rogiers X. Standard liver volume in the Caucasian population.  Liver Transpl Surg. 1999;  5 366-368
  • 32 Vauthey J N, Abdalla E K, Doherty D A et al.. Body surface area and body weight predict total liver volume in Western adults.  Liver Transpl. 2002;  8 233-240
  • 33 DeLand F H, North W A. Relationship between liver size and body size.  Radiology. 1968;  91 1195-1198
  • 34 Johnson T N, Tucker G T, Tanner M S, Rostami-Hodjegan A. Changes in liver volume from birth to adulthood: a meta-analysis.  Liver Transpl. 2005;  11 1481-1493
  • 35 Abdalla E K, Barnett C C, Doherty D, Curley S A, Vauthey J N. Extended hepatectomy in patients with hepatobiliary malignancies with and without preoperative portal vein embolization.  Arch Surg. 2002;  137 675-680
  • 36 Ribero D, Abdalla E K, Madoff D C et al.. Portal vein embolization before major hepatectomy and its effects on regeneration, resectability and outcome.  Br J Surg. 2007;  94 1386-1394
  • 37 Abdalla E K, Adam R, Bilchik A J et al.. Improving resectability of hepatic colorectal metastases: expert consensus statement.  Ann Surg Oncol. 2006;  13 1271-1280

Jean-Nicolas VautheyM.D. F.A.C.S. 

Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center

1515 Holcombe Boulevard, Unit 444, Houston, TX 77030

Email: jvauthey@mdanderson.org

    >