Assessment and optimization of liver volume before major hepatic resection: Current guidelines and a narrative review

Adeel S. Khan, Sandra Garcia-Aroz, Mohammad A. Ansari, Syed M. Atiq, Michael Senter-Zapata, Kathryn Fowler, M. B. Doyle, W. C. Chapman

Research output: Contribution to journalReview articlepeer-review

30 Scopus citations

Abstract

Post hepatectomy liver failure (PHLF) remains a significant cause of morbidity and mortality after major liver resection. Although the etiology of PHLF is multifactorial, an inadequate functional liver remnant (FLR) is felt to be the most important modifiable predictor of PHLF. Pre-operative evaluation of FLR function and volume is of paramount importance before proceeding with any major liver resection. Patients with inadequate or borderline FLR volume must be considered for volume optimization strategies such as portal vein embolization (PVE), two stage hepatectomy with portal vein ligation (PVL), Yttrium-90 radioembolization, and associating liver partition and portal vein ligation for staged hepatectomy (ALPPS). This paper provides an overview of assessing FLR volume and function, and discusses indications and outcomes of commonly used volume optimization strategies.

Original languageEnglish
Pages (from-to)74-81
Number of pages8
JournalInternational Journal of Surgery
Volume52
DOIs
StatePublished - Apr 2018

Keywords

  • ALLPS
  • Associating liver partition and portal vein ligation
  • Extended hepatectomy
  • Functional liver volume
  • Future liver remnant
  • Liver volume optimization
  • Portal vein embolization
  • Portal vein ligation
  • Two stage hepatectomy

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