[Prospective study of liver parenchyma volume in hepatectomy of primary liver cancer].

ABSTRACT

OBJECTIVE: To explore the secure resection margin (RM) of hepatectomy for primary liver cancer (PLC) with the coexistence of cirrhosis or hepatitis by studying the correlations of the resected liver parenchyma volume with postoperative liver function, complication and RM clinically. METHODS: The volume of tumor and the surrounding liver in resected liver specimen was measured and calculated in continuous 76 PLC patients prospectively, and the total liver parenchyma volume was measured and calculated using computed tomography (CT) images in former 40 patients. Under ideal circumstances, the surrounding liver volume, which would be resected theoretically, was calculated according to various sizes of tumors and RMs. The correlations of the resected liver volume or hepatic parenchyma-resected rate (HPRR) with postoperative liver function, complication and RM were analysed. RESULTS: The RM was (5 +/- 7) mm in 76 patients. The volume of the tumors and the surrounding liver in the specimens were (107 +/- 203) cm(3) and (153 +/- 120) cm(3), respectively. In 40 patients, the total nontumorous liver volume using CT images was (1079 +/- 179) cm(3), and HPRR was (14 +/- 9)%. There were statistically significant differences in HPRR (P < 0.05) between three groups with complication score 0, 1-2 and 3-6 points, the value of the first group were lower than that of the third group at the level P < 0.05. The significant factors affecting liver function and complication are HPRR, the size of operation, the time of hepatic portal occlusion and the resected liver volume (P < 0.05) apart from preoperative liver function. CONCLUSIONS: When hepatectomy was performed in PLC patients with preoperative liver function of Child A grade and the coexistence of cirrhosis or hepatitis, 30% HPRR was a lower limit for greatly increasing the chance of developing serious postoperative complications, while 20% HPRR was a safe upper limit for achieves quick postoperative recovery or developing only a few mild complications. When PLC patients without macroscopic tumor thrombi or macrosatellites undergo hepatectomy, 10 mm RM is enough to ensure sufficient liver function residue and achieve complete micrometastasis clearance in liver parenchyma surrounding the lesion if the diameter of a tumor is less than 10 cm and 6 mm RM is enough to ensure sufficient liver function residue and obtain 99% micrometastasis clearance if the diameter of a tumor is greater than 10 cm, while with macroscopic tumor thrombi or macrosatellites, 20 mm RM is enough to ensure sufficient liver function residue and achieve 99% micrometastasis clearance if the diameter of a tumor is less than 6 cm.