Simpson Amber L, Geller David A, Hemming Alan W, Jarnagin William R, Clements Logan W, D'Angelica Michael I, Dumpuri Prashanth, Gönen Mithat, Zendejas Ivan, Miga Michael I, Stefansic James D
Department of Biomedical Engineering, Vanderbilt University, Nashville, TN; Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY.
Liver Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, PA.
J Am Coll Surg. 2014 Aug;219(2):199-207. doi: 10.1016/j.jamcollsurg.2014.02.027. Epub 2014 Mar 27.
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.
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.
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).
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.
肝切除术后的残余肝脏体积（RLV）是围手术期结局的关键预测指标。本研究旨在调查肝脏手术规划软件在预测术后RLV及评估早期肝脏再生方面的准确性。
2008年6月至2010年期间，邀请符合肝切除条件的患者参与本研究。所有患者在切除术前及术后早期均接受了横断面成像检查（CT或MRI）。使用Scout Liver软件（Pathfinder Therapeutics Inc.）测量计划残余肝脏体积（pRLV）（基于术前扫描的计划切除）和术后实际残余肝脏体积（aRLV）（根据术后早期扫描确定）。分析pRLV与aRLV之间的差异，并对术后成像时间进行控制。将测量的全肝体积（TLV）与计算体积的标准公式进行比较。
2008年6月至2010年6月期间，3个治疗中心共有66例患者纳入本研究。发现pRLV与aRLV之间存在相关性（r = 0.941；p < 0.001），在考虑术后成像时间后相关性有所改善（r = 0.953；p < 0.001）。根据术后成像时间对pRLV至aRLV的相对体积偏差进行分层分析，结果显示术后5天开始出现可测量的肝脏再生迹象，8天时趋于稳定（p < 0.01）。对于肝脏体积处于极端值的患者，使用标准公式估算TLV的效果较差（某些情况下高达50%）。
术前对未来残余肝脏进行虚拟规划可准确预测肝切除术后的体积。术后早期肝脏再生在术后5天开始即可通过影像学测量。直接从CT扫描测量TLV而非基于公式计算可应对TLV的极端情况。
