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 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

121 Citations (Scopus)

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
Externally publishedYes

Fingerprint

Portal Vein
Neoplasm Metastasis
Mortality
Liver
Growth
Hypertrophy
Hepatic Insufficiency
Morbidity
ROC Curve
Area Under Curve
Regeneration

Keywords

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

ASJC Scopus subject areas

  • Surgery

Cite this

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

In: Journal of the American College of Surgeons, Vol. 216, No. 2, 01.02.2013, p. 201-209.

Research output: Contribution to journalArticle

Shindoh, Junichi ; Truty, Mark ; Aloia, Thomas A. ; Curley, Steven A. ; Zimmitti, Giuseppe ; Huang, Steven Y. ; Mahvash, Armeen ; Gupta, Sanjay ; Wallace, Michael J. ; Vauthey, Jean Nicolas. / 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. In: Journal of the American College of Surgeons. 2013 ; Vol. 216, No. 2. pp. 201-209.
@article{66a207134921438196bf7d5a92ef78de,
title = "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",
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).",
keywords = "degree of hypertrophy, DH, KGR, kinetic growth rate, portal vein embolization, PVE, receiver operating characteristics, ROC, sFLR, standardized future liver remnant",
author = "Junichi Shindoh and Mark Truty and Aloia, {Thomas A.} and Curley, {Steven A.} and Giuseppe Zimmitti and Huang, {Steven Y.} and Armeen Mahvash and Sanjay Gupta and Wallace, {Michael J.} and Vauthey, {Jean Nicolas}",
year = "2013",
month = "2",
day = "1",
doi = "10.1016/j.jamcollsurg.2012.10.018",
language = "English (US)",
volume = "216",
pages = "201--209",
journal = "Journal of the American College of Surgeons",
issn = "1072-7515",
publisher = "Elsevier Inc.",
number = "2",

}

TY - JOUR

T1 - Kinetic growth rate after portal vein embolization predicts posthepatectomy outcomes

T2 - Toward zero liver-related mortality in patients with colorectal liver metastases and small future liver remnant

AU - Shindoh, Junichi

AU - Truty, Mark

AU - Aloia, Thomas A.

AU - Curley, Steven A.

AU - Zimmitti, Giuseppe

AU - Huang, Steven Y.

AU - Mahvash, Armeen

AU - Gupta, Sanjay

AU - Wallace, Michael J.

AU - Vauthey, Jean Nicolas

PY - 2013/2/1

Y1 - 2013/2/1

N2 - 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).

AB - 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).

KW - degree of hypertrophy

KW - DH

KW - KGR

KW - kinetic growth rate

KW - portal vein embolization

KW - PVE

KW - receiver operating characteristics

KW - ROC

KW - sFLR

KW - standardized future liver remnant

UR - http://www.scopus.com/inward/record.url?scp=84872293314&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84872293314&partnerID=8YFLogxK

U2 - 10.1016/j.jamcollsurg.2012.10.018

DO - 10.1016/j.jamcollsurg.2012.10.018

M3 - Article

C2 - 23219349

AN - SCOPUS:84872293314

VL - 216

SP - 201

EP - 209

JO - Journal of the American College of Surgeons

JF - Journal of the American College of Surgeons

SN - 1072-7515

IS - 2

ER -