Hepatology, Vol 26, 1176-1181, Copyright ? 1997 by American Association for
the Study of Liver Diseases

Measurement of liver volume and hepatic functional reserve as a guide to
decision-making in resectional surgery for hepatic tumors

K Kubota, M Makuuchi, K Kusaka, T Kobayashi, K Miki, K Hasegawa, Y Harihara
and T Takayama Second Department of Surgery, Faculty of Medicine, University
of Tokyo, Japan.

The respective volumes of hepatic tumors and nontumorous parenchyma of 50
patients requiring hepatectomy of more than one segment of Healey for tumor
removal were measured using computed tomography (Vol-CT). The volume estimated
by Vol-CT was found to correlate with the real weight resected           (P <
.0001) with a mean absolute error of 64.9 mL. The ratio of the
nontumorous parenchymal volume of the resected liver to that of the whole
liver (R2) in 15 patients who underwent right or extended right hepatic
lobectomy was 43% +/- 15%. Eight of 15 patients with R2s < 60% underwent the
procedures without right portal vein embolization (PE). The other seven with
R2s exceeding 60% or an indocyanine green retention rate after 15 minutes
(ICG15) of 10% to 20% underwent PE: in six of seven, the nontumorous
parenchyma of the right hepatic lobe became atrophic and in all seven, the
volume of the remaining left hepatic lobe increased with a decrease in the
mean R2 from 62% +/-14% to 55% +/- 8% (P = .0006). In the remaining 35 who
underwent other hepatectomy procedures, R2s also remained <60%. Overall, at
surgery, in 27 with normal liver function (ICG15 < 10%), R2s exceeded 60% in
one, remained at 50% to
60% in five, and <50% in 21, whereas 23 patients except for one with an ICG15
exceeding 10%, had R2s of <50%. The postoperative serum total bilirubin levels
in 84% of the patients remained within the normal range and there was no
surgery-related mortality. In conclusion, 1) Vol-CT can accurately assess the
extent of liver resection, 2) individuals with normal liver function can
undergo resection of up to 60% of the nontumorous parenchyma without the need
for PE, and 3) PE can be used to reduce the size of the resected tissue and
increase the volume of the remnant liver to approximate the target limits in
individuals with large tumors or minimally abnormal liver function.

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