Preoperative measurement of the left hepatic vein axis predicts remnant liver hypertrophy after a right hepatectomy

Abstract

Introduction: Adequate remnant-liver hypertrophy (RLH) is a condition for successful major-hepatectomy. RLH is mainly dependent on the remnant-liver to total-liver volume ratio (RLTLV) but other anatomical factors, that may influence the quality of the inflow and outflow, may have an impact on RLH. The aim of this study was to determine the role of preoperative anatomical factors on RLH after a right-hepatectomy. Method: CT-scan (preoperative and Day-30) of 32 non-cirrhotic patients undergoing a right-hepatectomy have been reviewed by the same author (V.D.). Measurements of the portal-vein (PV) length and axis, the angle between the left portal vein (LPV) and the PV, as well as the axis (relative to a frontal plan going through the vena cava) of the median hepatic vein (MHV) and of the left hepatic vein (LHV) were performed. Preoperative RLTLV-ratio was calculated. RLH was calculated as: [(remnant-liver at Day-30 – preoperative remnant-liver) / preoperative remnant-liver]. Quantitative data are expressed as mean (CI95%). Results: Preoperative RLTLV-ratio was 34% (32-37). By contrast to MHV axis, LHV axis did not modify a lot after hepatectomy (MHV: +29.4°; LHV: +5.1°). RLH was +100% (82–119) and was negatively-correlated to preoperative RTLV (r = −0.75; p < 0.001) and positively-correlated to LHV-axis (r = 0.45; p = 0.01). Other preoperative measurements were not correlated to RLH. Adding LHV axis in a linear-regression model based on RLTLV alone increased its accuracy for the prediction of RLH (adjusted R2: 0.623 vs. 0.542; p = 0.02). Conclusion: For the same preoperative RLTLV-ratio, LHV-axis measurement could be a useful parameter to predict RLH after a right-hepatectomy.