What Is a Safe Future Liver Remnant Size in Patients Undergoing Major Hepatectomy for Colorectal Liver Metastases and Treated by Intensive Preoperative Chemotherapy?

Abstract

This study provides a cutoff FLR ratio for safe postoperative outcome after major hepatectomy in CLM patients receiving six or more cycles of preoperative chemotherapy.

ICG Clearance Test and 99mTc-GSA SPECT/CT Fusion Images

“…Using these ratios, several investigators have reported safe thresholds to prevent postoperative liver failure in non-cirrhotic patients [2][3][4]. However, a more cautious assessment of the functional aspects of remnant liver is required in patients with underlying liver disease such as cirrhosis, or in patients with impaired liver function due to chemotherapy for liver metastasis from colorectal cancer [5,6]. In addition, portal vein embolization (PVE) or associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) have been employed for extensive liver resection to avoid postoperative complications by inducing hypertrophy of the future remnant liver.…”

New Preoperative Images, Surgical Planning, and Navigation

“…Some commercially available workstations are installed on site and all processing and planning is performed by surgeons, radiology technicians, and radiologists [23][24][25]. Other planning services can be performed remotely per case, which entails the secure transfer of patient DICOM files, subsequent image processing, and the return of a detailed analysis to the hospital [26].…”

Designing Liver Resections and Pushing the Envelope with Resections for Hepatic Colorectal Metastases

“…The multidisciplinary team must determine whether a margin-negative resection is achievable and that an adequate amount of liver with intact vascular inflow and outflow and biliary drainage will remain post-resection in order to prevent post-operative hepatic failure. The volume of liver parenchyma that will remain after resection, i.e., the future liver remnant (FLR), is of paramount importance in hepatic resections [11][12][13]. Conventionally 20 % of the total liver volume has been regarded as the minimum safe FLR in a patient with normal hepatic function [7]; however, an FLR of 30-40 % is necessary if the patient has received cytotoxic chemotherapy, since chemotherapeutic agents used to treat CRC cause hepatic injury, such as steatosis and sinusoidal obstruction with oxaliplatin and steatohepatitis with irinotecan [12,14].…”