This document discusses several tools for evaluating liver function and predicting postoperative outcomes following hepatic resection. It mentions several studies that found:
- Remnant liver volume/body weight ratio (RLV/BWR) of less than 0.5% was a risk factor for hepatic dysfunction after right trisectionectomy.
- Only a hepatic venous pressure gradient greater than 10 mmHg was a significant risk factor for decompensated cirrhosis after surgery in univariate analysis.
- Indocyanine green retention rate at 15 minutes was significantly higher in patients who died compared to survivors following hepatic resection.
- A posthepatectomy portal vein pressure over 22.5 mmHg was an independent predictor of liver failure and mortality
3. Truant, JACS 2007
• RLV-BWR was more relevant than RLV-TLV in predicting postoperative course after
right trisectionectomy
• Patients with an anticipated RLV < 0,5% of the body weight were at risk of hepatic
dysfunction
• No deaths in the group of patients with RLV/BWR >0,5%
6. 29 patients pour CHC uninodulaire Child A
Only hepatic venous pressure gradient > 10 mmHg was significant
in multivariate analysis for decompensated cirrhosis after hepat.
Risk factor in univariate analysis
Bilirubin rate
Urea rate
Rate of platelet
ICG Clearence
Hepatic venous pressure gradiant,
1996
Décompensation de la cirrhose : Persistance d’une ascite à 3 mois
12. Correlation is linear…
YesNo
PosthepatectomyPVP(mmHg)
22.5 mmHg
15 mmHg
P < 0.001
Liver failure « 50-50 » criteria
Portal pressure after major liver resection
An independent predictor of liver failure and mortality
after major resection (N = 277) in humans1
Allard, Ann Surg 2013
13. Comment évaluer la réserve fonctionnelle: les autres
paramètres
Scintigraphie hépatique
De Graaf, J Nucl Med 2010