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

1. Les outils d’evaluation
Daniel Cherqui – Andrea Laurenzi

2. Stone, Am J Surg 1969

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%

4. Remnant liver volume assessment
Truant, World J Surg 2015

5. Shin, JGIS 2007

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

7. Cucchetti, J Hep 2016

8. Makuuchi, Semin Surg Oncol 1993
Ascites
None or controlled Not controlled
ICGR15 Limited resection Enucleation Not indicated for hepatectomy
Trisectorectomy
bisectorectomy
Left-sided
hepatectomy
Right-sided
sectoriectomy
Segmentectomy Limited resection Enucleation
Normal 1.1 – 1.5 mg/dL 1.6 – 1.9 mg/dL > 2.0 mg/dL
Total bilirubin level
Normal 10% - 19% 30% - 39% > 40%20% - 29%
Adapter la chirurgie hépatique à la
fonction…

9. Survivors (n = 113) Non-survivors (n = 14) P *
All ICG retention at 15 min (%) 11 (3 - 50) 18 (4 - 29) 0.008
Aminopyrine breath test (%) 4-4 (1.3 - 9.6) 4.3 (2.8 – 8.3) 0.69
Amino acid clearance test (1 m-2 min-1) 0.21(1.7 to 4.3) 0.15 (-0.2 to 0.9) 0.35
Albumin (g l-1) 42 (31 - 53) 41 (29 - 46) 0.40
Total bilirubin (µmol l-1) 9 (3 - 70) 14 (7 - 32) 0.05
Aspartate aminotransferase (units l-1) 59 (17 - 365) 97 (39 - 340) 0.02
Alanine aminotransferase (units l-1) 53 (9 - 480) 53 (21 - 322) 0.90
0
15
35
[IGC]mg%
Survivors
Distribution of indocyanine green (ICG) retention at
? in for survivors and patients who died in hospital
Non-survivors
5
25
40
10
20
45
30
 127 hepatectomies dont 91 Majeures
 Child A (n=121) / Child B (n=6)
 Mortalité Hospitalière : 14/127 (11%)
 Valeur seuil d’ICG à 15 minutes
15% pour les Hep. Maj
23% pour les Hep. Min.
Lau, BJS 1997

10. 90 pts including including 17 major hep. : 30% of liver decompensation (20% ascite)
Cescon, Ann Surg 2012

11. > 16 kpA: Ascite and/or POLF
Cescon, Ann Surg 2012

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