PLANNING OF EXTENDED HEPATIC RESECTIONS

Burlaka A.A.

The volume of the future liver stump (LS) is a critical factor in hepatobiliary surgery, since it re­presents potential risk factors for acute hepatic fai­lure (AHF) in the postoperative period. Despite this, today there is no single solution within the consensus regarding the safe minimum volume of LS parenchyma and the choice of modality for calculating this vo­lume. Objective: to analyze the results of own experience and recent literature data on precise determination of optimal approach for volumetry implementation for li­ver resection. Object and methods: in 15 clinical ca­ses according to results of magnetic resonance imaging/computed tomography (MRI/CT) volumetric measurements were performed retrospectively on the abdominal cavity. The data of patients who have undergone extensive or «large» liver resections with regard to malignant neoplasms of the liver and its metasta­tic lesion have been studied. Calculation of liver vo­lume and its sections/segments was performed using Extended Brilliance Workstation, Philips, Eindhoven, the Netherlands; Onis 2.5 (http://www.onis-viewer.com/ProductInfo.aspx?id=19) and Varian Eclipse. Results: pre-operative calculation of the volume of LS, precise study of variant vascular and biliary anatomy of the liver are critical for reducing the level of surgical complications, especially in the planning of «large» resections. The necessary stage in the preoperative examination, when calculating the minimum allowable vo­lume of tissue in the planning of «large» resections, is volumetric liver and its individual anatomical structures. An analysis of the results and literature data shows a reliable correlation between the manual and semi-­automatic method of performing liver volumetry and its individual segments/sections. Conclusions: MRI and CT images are equivalent, self-sufficient and high informative methods for liver volumetric implementation. The conducted X-ray image analysis demonstrated that manual volumetry using independent software allows to effectively predict the future volume of future LS and the risks of ALF in the postoperative period.