After a major liver resection the patient may be left with a small remnant liver volume. Hypertrophy in liver segments 2 and 3 may be sufficient to avoid hepatic insufficency. Mise et al developed a nomogram to predict the degree of hypertrophy in these segments.
Patient selection: extended right hepatectomy with right portal vein embolization (RPVE)
Outcome: percentage hypertrophy in segments 2 and 3 following therapy
Parameters:
(1) body mass index (BMI) over range from 16 to 48 kg per square meter
(2) history of previous hepatectomy
(3) 2 stage porcedure (RPVE followed by right hepatectomy, usually performed in patients with bilateral colorectal liver metastases)
(4) segment 4 embolization
points for BMI =
= 150 - (3.125 * (BMI))
Parameters |
Findings |
Points |
previous hepatectomy |
no |
52.6 |
|
yes |
0 |
2-stage procedure |
no |
46 |
|
yes |
0 |
segment 4 embolization |
no |
0 |
|
yes |
33.6 |
total score =
= SUM(points for all 4 parameters)
Interpretation:
• minimum score: 0
• maximum score: 232.2
• The higher the score the greater the hypertrophy in segments 2 and 3.
Total Points |
Percent Hypertrophy |
< 57 |
< 3% |
57 to 236.3 |
(0.0504 * (points)) + 0.1016 |
Specialty: Gastroenterology, Surgery, general, Surgery, orthopedic