Liver planning software accurately predicts postoperative liver volume and measures early regeneration.

BACKGROUND Postoperative or remnant liver volume (RLV) after hepatic resection is a critical predictor of perioperative outcomes. This study investigates whether the accuracy of liver surgical planning software for predicting postoperative RLV and assessing early regeneration. STUDY DESIGN Patients eligible for hepatic resection were approached for participation in the study from June 2008 to 2010. All patients underwent cross-sectional imaging (CT or MRI) before and early after resection. Planned remnant liver volume (pRLV) (based on the planned resection on the preoperative scan) and postoperative actual remnant liver volume (aRLV) (determined from early postoperative scan) were measured using Scout Liver software (Pathfinder Therapeutics Inc.). Differences between pRLV and aRLV were analyzed, controlling for timing of postoperative imaging. Measured total liver volume (TLV) was compared with standard equations for calculating volume. RESULTS Sixty-six patients were enrolled in the study from June 2008 to June 2010 at 3 treatment centers. Correlation was found between pRLV and aRLV (r = 0.941; p < 0.001), which improved when timing of postoperative imaging was considered (r = 0.953; p < 0.001). Relative volume deviation from pRLV to aRLV stratified cases according to timing of postoperative imaging showed evidence of measurable regeneration beginning 5 days after surgery, with stabilization at 8 days (p < 0.01). For patients at the upper and lower extremes of liver volumes, TLV was poorly estimated using standard equations (up to 50% in some cases). CONCLUSIONS Preoperative virtual planning of future liver remnant accurately predicts postoperative volume after hepatic resection. Early postoperative liver regeneration is measureable on imaging beginning at 5 days after surgery. Measuring TLV directly from CT scans rather than calculating based on equations accounts for extremes in TLV.

[1]  Yuman Fong,et al.  Improvement in Perioperative Outcome After Hepatic Resection: Analysis of 1,803 Consecutive Cases Over the Past Decade , 2002, Annals of surgery.

[2]  D. D. Bois,et al.  CLINICAL CALORIMETRY: TENTH PAPER A FORMULA TO ESTIMATE THE APPROXIMATE SURFACE AREA IF HEIGHT AND WEIGHT BE KNOWN , 1916 .

[3]  E. J. van der Jagt,et al.  Early hepatic regeneration index and completeness of regeneration at 6 months after partial hepatectomy , 2012, The British journal of surgery.

[4]  D. DuBois,et al.  A formula to estimate the approximate surface area if height and weight be known , 1989 .

[5]  Heinz-Otto Peitgen,et al.  Impact of virtual tumor resection and computer-assisted risk analysis on operation planning and intraoperative strategy in major hepatic resection. , 2005, Archives of surgery.

[6]  Michael I. Miga,et al.  Model-Assisted Image-Guided Liver Surgery Using Sparse Intraoperative Data , 2012 .

[7]  Steven A Curley,et al.  Three Hundred and One Consecutive Extended Right Hepatectomies: Evaluation of Outcome Based on Systematic Liver Volumetry , 2009, Annals of surgery.

[8]  R. Davies.  Hypothesis Testing when a Nuisance Parameter is Present Only Under the Alternatives , 1987 .

[9]  A. Bowman,et al.  Applied smoothing techniques for data analysis : the kernel approach with S-plus illustrations , 1999 .

[10]  Yoshihiro Sakamoto,et al.  Virtual liver resection: computer-assisted operation planning using a three-dimensional liver representation , 2013, Journal of hepato-biliary-pancreatic sciences.

[11]  T. Hwang,et al.  Human liver regeneration after major hepatectomy. A study of liver volume by computed tomography. , 1991, Annals of surgery.

[12]  浦田 浩一,et al.  Calculation of child and adult standard liver volume for liver transplantation , 1995 .

[13]  P. Fox,et al.  Evaluation of new algorithms for the interactive measurement of surface area and volume. , 1994, Medical physics.

[14]  M. Ando,et al.  Liver regeneration after major hepatectomy for biliary cancer , 2001, The British journal of surgery.

[15]  R. Davies.  Hypothesis testing when a nuisance parameter is present only under the alternative , 1977 .

[16]  D. Seehofer,et al.  Function and volume recovery after partial hepatectomy: influence of preoperative liver function, residual liver volume, and obesity , 2012, Langenbeck's Archives of Surgery.

[17]  S. Heymsfield,et al.  Accurate measurement of liver, kidney, and spleen volume and mass by computerized axial tomography. , 1979, Annals of internal medicine.

[18]  Lawrence H. Schwartz,et al.  Volumetric analysis predicts hepatic dysfunction in patients undergoing major liver resection , 2003, Journal of Gastrointestinal Surgery.

[19]  V. Vilgrain,et al.  Liver regeneration at day 7 after right hepatectomy: global and segmental volumetric analysis by using CT. , 2009, Radiology.

[20]  Roland Materne,et al.  Body surface area and body weight predict total liver volume in Western adults , 2002, Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society.

[21]  V. Muggeo.  Estimating regression models with unknown break‐points , 2003, Statistics in medicine.

[22]  B. Dawant,et al.  Liver segmentation in living liver transplant donors: comparison of semiautomatic and manual methods. , 2005, Radiology.

[23]  D. Yoon,et al.  Difference of regeneration potential between healthy and diseased liver. , 2012, Transplantation proceedings.

[24]  R. Howard,et al.  Hepatic Vein Reconstruction for Resection of Hepatic Tumors , 2002, Annals of surgery.

[25]  S J Wigmore,et al.  The value of residual liver volume as a predictor of hepatic dysfunction and infection after major liver resection , 2005, Gut.

[26]  Masakazu Yamamoto,et al.  Novel virtual hepatectomy is useful for evaluation of the portal territory for anatomical sectionectomy, segmentectomy, and hemihepatectomy , 2013, Journal of hepato-biliary-pancreatic sciences.

[27]  Rosen,et al.  Management of Hepatic Metastases. , 1998, Cancer control : journal of the Moffitt Cancer Center.

[28]  J. Fujimoto,et al.  Dynamics of normal and injured human liver regeneration after hepatectomy as assessed on the basis of computed tomography and liver function , 1993, Hepatology.

[29]  齊藤 慎一.  A novel 3D hepatectomy simulation based on liver circulation : application to liver resection and transplantation , 2005 .

[30]  A. Tsung,et al.  Right Hepatic Lobectomy Using the Staple Technique in 101 Patients , 2008, Journal of Gastrointestinal Surgery.

[31]  Kunio Doi,et al.  Automated hepatic volumetry for living related liver transplantation at multisection CT. , 2006, Radiology.

[32]  L. Price,et al.  LIVER REGENERATION AND SURGICAL OUTCOME IN DONORS OF RIGHT‐LOBE LIVER GRAFTS , 2003, Transplantation.

[33]  Yohan Payan,et al.  SOFT TISSUE BIOMECHANICAL MODELING FOR COMPUTER ASSISTED SURGERY: CHALLENGES AND PERSPECTIVES , 2016 .

[34]  T. Utsunomiya,et al.  Postoperative liver failure after major hepatic resection for hepatocellular carcinoma in the modern era with special reference to remnant liver volume. , 1999, Journal of the American College of Surgeons.

[35]  Martin Styner,et al.  Comparison and Evaluation of Methods for Liver Segmentation From CT Datasets , 2009, IEEE Transactions on Medical Imaging.

[36]  K. Do,et al.  Standardized measurement of the future liver remnant prior to extended liver resection: methodology and clinical associations. , 2000, Surgery.

[37]  J. Shindoh,et al.  Adjuvant Chemotherapy With FOLFOX for Primary Colorectal Cancer Is Associated With Increased Somatic Gene Mutations and Inferior Survival in Patients Undergoing Hepatectomy for Metachronous Liver Metastases , 2012, Annals of surgery.

[38]  A. Sardi,et al.  Management of primary and metastatic tumors to the liver. , 1996, Oncology.

[39]  P Stolzmann,et al.  CT- and MRI-based volumetry of resected liver specimen: comparison to intraoperative volume and weight measurements and calculation of conversion factors. , 2010, European journal of radiology.