Liver Volume Measured By CT As A Predictor Of Hepatic Dysfuntion After Hepatic Resection For The Patients With Hepatocellular Carcinoma

Background and ObjectivePrimary liver cancer (PLC) is a major malignant tumor which is harmful to our health. China belongs the one of the highest incidence area. There is about 260,000 exposure to PLC in our country and the mortality of PLC occupies the second site of malignant tumor. Hepatic resection is the first selection for treating PLC and it is also thought as the only one which can cure PLC. With the development of medical technique, the mortality after hepatic resection has steadily decreased. But postoperation liver failure is still occur on some patients. In China, there are 72.1-82.3% PLC patients with associated liver cirrhosis. It is important to accurately evaluate the hepatic functional reserve beforehepatectomy. Especially in patients with associated liver cirrhosis, whose hepatic functional reserve and regeneration are poor. Liver volumetric parameter is important to evaluate the hepatic functional reserve. In this study, total liver volume (TLV) and tumour volume (TuV) are measured by MSCT (multiple-slice spiral CT, Philips Medical System). Using three dimensional hepatic volumetry and virtual resection to calculate the residual liver volume (RLV) and Relative residual liver volume ( %RLV ). The aim of this study is to document the relationship of RLV and %RLV between hepatic function postoperation in hepatocellular carcinoma (HCC) patients.Materials and MethodsRetrospective analysis of 113 hepatocellular carcinoma (HCC) patients undergoing hepatectomy in our hospital from July 2001 to July 2003. Total liver volume (TLV) and tumour volume (TuV) are measured by MSCT (multiple-slice spiral CT, Philips Medical System). Using three dimensional hepatic volumetry and virtual resection according to the record of operation to calculate the residual liver volume (RLV). Total functional livr volume (TFLV) was calculated by subtracting tumour liver volume from total liver volume ( TFLV = TLV - TuV ). Relative residual liver volume ( %RLV ) was expressed as a percentage of TELV( %RLV = RLV / TFLV ). One way ANOVA analysis was used in order to assess differences in %RLV and RLV between patients with different severities of hepatic dysfunction.ResultsMild, moderate, and severe hepatic dysfunction were evident in 70, 28, and11 patients. 4 cases were developed postoperative hepatic function failure. Mean RLV was significantly different between all groups(p=0.027). Mean %RLV was 86(SD10)% in mild hepatic dysfunction group, 84(SD13)% in moderate group, 73(SD18)% in severe group, 53(SD12)% in liver failure group. One way between groups ANOVA1: p=0.000. LSD multiple comparisons show that it is significantly different between all groups. Serum ChE before hepatectomy and operation time were significantly correlative to hepatic dysfunction after operation.ConclusionIt has close relationship between RLV and %RLV with the severity of hepatic dysfuction. The likelihood of hepatic function failure following liver resection can be predicted by residual liver volume and relative residual liver volume (%RLV). Shorten the operation time can decreace the risk of operation. Serum ChE changes with the severity of cirrhotic liver, appears to be a good predictor for liver reserve function.