I Liver Volume Predicted Postoperative Liver Dysfunction

Objective:To assess the relationship between remnant liver volume and postoperative hepatic dysfuncion in cirrhotic patients with hepatitis B infection undergoing hemihepatectomy or extended hemihepatectomy.Patients and method:Liver volumetry was performed on computer models derived from computed tomography of cirrhotic patients with Hepatitis B infection who scheduled for hemihepatectomy,and was standardized by body surface area.The postoperative hepatic dysfunction was defined as a serum bilirubin concentration greater than 5.0mg/dl,a prothrombin time rate of less than 50%for 3 or more consecutive days,or both.The relation between postoperative hepatic dysfunction and standardized remnant liver volume(SRLV) and standardized remnant liver volume ration(SRLVR) as well as other clinicopathological factors was analyzed.Univariate analysis and multivariate logistic regression analysis were performed to delineate perioperative predictors of postoperative hepatic dysfunction.Results:Remnant liver volume was calculated in 49 patients from December 2003 to March 2007.Of them,43 patients received hemihepatectomy,including right hemihepatectomy or extended right hemihepatectomy in 37 cases and left hemihepatectomy or extended left hemihepatectomy in 6 cases.11 patients developed postoperative hepatic dysfunction(25.6%).SRLVR＜50%(p=0.014),prolonged prothrombin time(p=0.016) and perioperative blood transfusion(p=0.037) were found to be significant independent predictors of postoperative liver dysfunction.Conclusion:The likelihood of postoperative hepatic dysfunction can be predicted by a lower standardized remnant liver volume ration in patients with cirrhotic liver.Other preoperative assessment of liver function should be combined with remnant liver volume analysis for patient selection and deciding the extent of hepatic resection.