Kinetic growth rate after portal vein embolization predicts posthepatectomy outcomes: Toward zero liver-related mortality in patients with colorectal liver metastases and small future liver remnant

Junichi Shindoh, Mark J. Truty, Thomas A. Aloia, Steven A. Curley, Giuseppe Zimmitti, Steven Y. Huang, Armeen Mahvash, Sanjay Gupta, Michael J. Wallace, Jean Nicolas Vauthey

Research output: Contribution to journalArticle

140 Scopus citations

Abstract

Background: Standardized future liver remnant (sFLR) volume and degree of hypertrophy after portal vein embolization (PVE) have been recognized as important predictors of surgical outcomes after major liver resection. However, the regeneration rate of the FLR after PVE varies among individuals and its clinical significance is unknown. Study Design: Kinetic growth rate (KGR) is defined as the degree of hypertrophy at initial volume assessment divided by number of weeks elapsed after PVE. In 107 consecutive patients who underwent liver resection for colorectal liver metastases with an sFLR volume >20%, the ability of the KGR to predict overall and liver-specific postoperative morbidity and mortality was compared with sFLR volume and degree of hypertrophy. Results: Using receiver operating characteristic analysis, the best cutoff values for sFLR volume, degree of hypertrophy, and KGR for predicting postoperative hepatic insufficiency were estimated as 29.6%, 7.5%, and 2.0% per week, respectively. Among these, KGR was the most accurate predictor (area under the curve 0.830 [95% CI, 0.736-0.923]; asymptotic significance, 0.002). A KGR of <2% per week vs ≥2% per week correlates with rates of hepatic insufficiency (21.6% vs 0%; p = 0.0001) and liver-related 90-day mortality (8.1% vs 0%; p = 0.04). The predictive value of KGR was not influenced by sFLR volume or the timing of initial volume assessment when evaluated within 8 weeks after PVE. Conclusions: Kinetic growth rate is a better predictor of postoperative morbidity and mortality after liver resection for small FLR than conventional measured volume parameters (ie, sFLR volume and degree of hypertrophy).

Original languageEnglish (US)
Pages (from-to)201-209
Number of pages9
JournalJournal of the American College of Surgeons
Volume216
Issue number2
DOIs
StatePublished - Feb 1 2013

Keywords

  • DH
  • KGR
  • PVE
  • ROC
  • degree of hypertrophy
  • kinetic growth rate
  • portal vein embolization
  • receiver operating characteristics
  • sFLR
  • standardized future liver remnant

ASJC Scopus subject areas

  • Surgery

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