Vishal Parikh BS, Presenter: Nothing to Disclose

Salvatore Gruttadauria MD, Abstract Co-Author: Nothing to Disclose

Duilio Pagano, Abstract Co-Author: Nothing to Disclose

Gianluca Marrone MD, Abstract Co-Author: Nothing to Disclose

Fabio Tuzzolino, Abstract Co-Author: Nothing to Disclose

Angelo Luca MD, Abstract Co-Author: Nothing to Disclose

If liver regeneration after a large hepatic resection is inadequate, the liver may not be functional enough to sustain metabolic needs, leading to “small-for-size” syndrome. Currently, liver regeneration after resection is heterogeneous and difficult to predict prior to surgery. Our goal was to identify pre-surgical predictors of liver regeneration.

This is a retrospective analysis of 100 liver resections performed at a single referral center from November 2004 to January 2010. Seventy patients were right lobe living donors and 30 patients underwent liver resection for metastatic tumors. Liver regeneration was evaluated by multi-detector computed tomography (MDCT) after surgery. Pre-surgical predictors of liver regeneration such as age, weight, height, body mass index (BMI), liver function tests, creatinine, platelet count, and variables detected at the pre-operative MDCT imaging including diameter of main portal vein, steatosis, total liver volume, future remnant liver volume (FRLV), and spleen volume were assessed. FRLV was calculated prior to surgery by MDCT using a virtual surgical cut. Sufficient hepatic regeneration was defined as a percent of liver regeneration greater than 50% following surgery.

Sufficient liver regeneration occurred in 79 (79%) of patients. There were no significant differences in liver regeneration between right lobe living donors and patients underwent resection for metastatic tumors. The stepwise regression analysis showed that predictors of good liver regeneration were younger age (coefficient = -0.54; P<0.05), higher BMI (4.07; P<0.001), lower serum albumin (-12.09; P<0.05), smaller FRLV (-0.15; P<0.001), greater spleen volume (57.78; P<0.001) and longer time of follow-up (0.54; P<0.01).

Patients characteristics (age, BMI and serum albumin) and parameters detectable by MDCT (FRLV and spleen volume) are good predictors of liver regeneration. These parameters should be included in pre-operative evaluation of patients about to undergo large hepatectomy.

Pre-surgical evaluation of FRLV and spleen volume by MDCT is useful in identifying patients with good liver regeneration after large hepatectomy and should be included when evaluating these patients.

Parikh, V, Gruttadauria, S, Pagano, D, Marrone, G, Tuzzolino, F, Luca, A, Role of MDCT to Evaluate Liver Regeneration after Large Hepatectomy: A Multiple Regression Analysis.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11004453.html