Volumetric Analysis Predicts Hepatic Dysfunction in Patients Undergoing Major Liver Resection

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  • معلومة اضافية
    • Author-Supplied Keywords:
      Hepatic dysfunction
      liver resection
      metastasis
    • Abstract:
      Liver-enhancing modalities, such as portal vein embolization, are increasingly employed prior to major liver resection to prevent postoperative liver dysfunction. Selection criteria for such techniques are not well described. This study uses CT-based volumetric analysis as a tool to identify patients at highest risk for postoperative hepatic dysfunction. Between July 1999 and December 2000, a total of 126 consecutive patients who were undergoing liver resection for colorectal metastasis and had CT scans at our institution were included in the analysis. Volume of resection was determined by semiautomated contouring of the liver on preoperative volumetrically (helical) acquired CT scans. Hepatic dysfunction was defined as prothrombin time greater than 18 seconds or serum bilirubin level greater than 3 mg/dl. Marginal regression was used to compare the predictive ability of volumetric analysis and the extent of resection. The percentage of liver remaining was closely correlated with increasing prothrombin time and bilirubin level (P < 0.001). After trisegmentectomy, 90% of patients with ≤25% of liver remaining developed hepatic dysfunction, compared with none of the patients with more than 25% of liver remaining after trisegmentectomy (P < 0.0001). The percentage of liver remaining was more specific in predicting hepatic dysfunction than was the anatomic extent of resection (P = 0.003). Male sex nearly doubled the risk of hepatic dysfunction (odds ratio = 1.89, P = 0.027), and having ≤25% of liver remaining more than tripled the risk (odds ratio = 3.09, P < 0.0001). Hepatic dysfunction and ≤25% of liver remaining were associated with increased complications and length of hospital stay (P < 0.0001 and P = 0.0003, respectively). Preoperative assessment of future liver volume remaining distinguishes which patients undergoing liver resection will most likely benefit from preoperative liver enhancement techniques such as portal vein embolization. ( J Gastrointest Surg 2003;7:325–330.) [Copyright &y& Elsevier]
    • Abstract:
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    • Author Affiliations:
      1Departments of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY USA
      2Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY USA
      3Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY USA
    • ISSN:
      1091-255X
    • Accession Number:
      10.1016/S1091-255X(02)00370-0
    • Accession Number:
      9340196
  • Citations
    • ABNT:
      SHOUP, M. et al. Volumetric Analysis Predicts Hepatic Dysfunction in Patients Undergoing Major Liver Resection. Journal of Gastrointestinal Surgery, [s. l.], v. 7, n. 3, p. 325–330, 2003. DOI 10.1016/S1091-255X(02)00370-0. Disponível em: http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=asn&AN=9340196&custid=s8280428. Acesso em: 18 fev. 2020.
    • AMA:
      Shoup M, Gonen M, D’Angelica M, et al. Volumetric Analysis Predicts Hepatic Dysfunction in Patients Undergoing Major Liver Resection. Journal of Gastrointestinal Surgery. 2003;7(3):325-330. doi:10.1016/S1091-255X(02)00370-0.
    • APA:
      Shoup, M., Gonen, M., D’Angelica, M., Jarnagin, W. R., DeMatteo, R. P., Schwartz, L. H., Tuorto, S., Blumgart, L. H., & Fong, Y. (2003). Volumetric Analysis Predicts Hepatic Dysfunction in Patients Undergoing Major Liver Resection. Journal of Gastrointestinal Surgery, 7(3), 325–330. https://doi.org/10.1016/S1091-255X(02)00370-0
    • Chicago/Turabian: Author-Date:
      Shoup, Margo, Mithat Gonen, Michael D’Angelica, William R. Jarnagin, Ronald P. DeMatteo, Lawrence H. Schwartz, Scott Tuorto, Leslie H. Blumgart, and Yuman Fong. 2003. “Volumetric Analysis Predicts Hepatic Dysfunction in Patients Undergoing Major Liver Resection.” Journal of Gastrointestinal Surgery 7 (3): 325–30. doi:10.1016/S1091-255X(02)00370-0.
    • Harvard:
      Shoup, M. et al. (2003) ‘Volumetric Analysis Predicts Hepatic Dysfunction in Patients Undergoing Major Liver Resection’, Journal of Gastrointestinal Surgery, 7(3), pp. 325–330. doi: 10.1016/S1091-255X(02)00370-0.
    • Harvard: Australian:
      Shoup, M, Gonen, M, D’Angelica, M, Jarnagin, WR, DeMatteo, RP, Schwartz, LH, Tuorto, S, Blumgart, LH & Fong, Y 2003, ‘Volumetric Analysis Predicts Hepatic Dysfunction in Patients Undergoing Major Liver Resection’, Journal of Gastrointestinal Surgery, vol. 7, no. 3, pp. 325–330, viewed 18 February 2020, .
    • MLA:
      Shoup, Margo, et al. “Volumetric Analysis Predicts Hepatic Dysfunction in Patients Undergoing Major Liver Resection.” Journal of Gastrointestinal Surgery, vol. 7, no. 3, Mar. 2003, pp. 325–330. EBSCOhost, doi:10.1016/S1091-255X(02)00370-0.
    • Chicago/Turabian: Humanities:
      Shoup, Margo, Mithat Gonen, Michael D’Angelica, William R. Jarnagin, Ronald P. DeMatteo, Lawrence H. Schwartz, Scott Tuorto, Leslie H. Blumgart, and Yuman Fong. “Volumetric Analysis Predicts Hepatic Dysfunction in Patients Undergoing Major Liver Resection.” Journal of Gastrointestinal Surgery 7, no. 3 (March 2003): 325–30. doi:10.1016/S1091-255X(02)00370-0.
    • Vancouver/ICMJE:
      Shoup M, Gonen M, D’Angelica M, Jarnagin WR, DeMatteo RP, Schwartz LH, et al. Volumetric Analysis Predicts Hepatic Dysfunction in Patients Undergoing Major Liver Resection. Journal of Gastrointestinal Surgery [Internet]. 2003 Mar [cited 2020 Feb 18];7(3):325–30. Available from: http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=asn&AN=9340196&custid=s8280428