Abstracts
2002 Digestive Disease Week

# 104863 Abstract ID: 104863 Volumetric Analysis Predicts Hepatic Dysfunction in Patients Undergoing Trisegmentectomy
Margo Shoup, Mithat Gonen, William R Jarnagin, Ronald P Dematteo, Leslie H Blumgart, Lawrence H Schwartz, Yuman Fong, New York, NY

PURPOSE: Liver enhancing modalities, such as portal vein embolization, are increasingly employed prior to major liver resection to prevent postoperative liver dysfunction. However, selection criteria for such techniques are not well described. This goal of this study was to utilize CT-based volumetric analysis as a tool to identify patients at highest risk for hepatic dysfunction. METHODS: Between July 1999 and December 2000, 126 consecutive patients having liver resection for colorectal metastasis who had CT scans at our institution were included in the analysis. Volume of resection was determined by semiautomated contouring of the liver on preoperative volumetrically (helical) acquired CT scans. Extensive liver resection was defined as having ?25% liver remaining (LR). Hepatic dysfunction was defined as prothrombin time (PT) > 18sec and/or bilirubin >3mg/dl. Fishers exact test was used to compare hepatic dysfunction in those patients having trisegmentectomy with ?25%LR to those having trisegmentectomy with >25%LR. RESULTS: Among all 126 patients, volumetric identification of resections resulting in ?25%LR was more specific (81%) and more sensitive (90%) in predicting liver dysfunction than was trisegmentectomy alone (52%, 77%, respectively). Of the 106 patients with >25%LR, hepatic dysfunction occurred in only 19%. 33/126 (26%) patients had a trisegmentectomy and 20/33 (61%) had ?25%LR. The table compares hepatic dysfunction in trisegmentectomy patients with ?25%LR to trisegmentectomy with >25% LR. CONCLUSION: Hepatic dysfunction occurred in the majority of patients undergoing trisegmentectomy with ?25%LR, but was not present in any of the trisegmentectomy patients with >25%LR. Volumetric analysis of future liver volume remaining predicts hepatic dysfunction in patients undergoing trisegmentectomy. This tool will aid in selecting those who will most likely benefit from preoperative liver enhancement techniques such as portal vein embolization.