Future liver remnant volumetry: an E-AHPBA international survey of current practice among liver surgeons

IF 3.3 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Hpb Pub Date : 2025-06-01 Epub Date: 2025-02-19 DOI:10.1016/j.hpb.2025.02.005

Tim Reese , Stefan Gilg , Joris Erdmann , Eduard Jonas , Karl J. Oldhafer , Ernesto Sparrelid , The Scientific and Research Committee of the European-African Hepato-Pancreato-Biliary Association

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Abstract

Background

Accurate assessment of the future liver remnant (FLR) is crucial for predicting the risk of post-hepatectomy liver failure (PHLF). This survey aims to evaluate the current practices of liver surgeons regarding FLR volumetry and its clinical use.

Methods

A cross-sectional survey was conducted among 212 liver surgeons to assess their use of FLR volumetry and associated methodologies. The survey consisted of 40 questions distributed in five sections covering multiple aspects of FLR volumetry.

Results

Ninety percent of respondents utilize preoperative FLR volumetry. However, there is significant variability in the methods used for FLR calculation and the thresholds for safe liver resection, which deviate from the proposed 20/30/40 % rule. Before right hepatectomy, 21 % of respondents indicated that they rarely or never utilise volumetry. Extended resections are the surgical procedures in which volumetry is most frequently employed. Furthermore, the kinetic growth rate is not widely adopted in clinical decision making.

Conclusion

This survey highlights the widespread use of FLR volumetry, but also reveals substantial variation in its application. This demonstrates a lack of evidence or guidelines regarding the appropriate use of FLR volumetry.

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未来肝残量测量：E-AHPBA对肝脏外科医生当前实践的国际调查。

背景：准确评估未来肝残余（FLR）对于预测肝切除术后肝衰竭（PHLF）的风险至关重要。本调查旨在评估当前肝外科医生关于FLR体积测量及其临床应用的做法。方法：对212名肝脏外科医生进行横断面调查，以评估他们使用FLR容积法和相关方法的情况。调查包括40个问题，分布在五个部分，涵盖了FLR容积法的多个方面。结果：90%的应答者使用术前FLR容积测定。然而，计算FLR的方法和安全肝切除的阈值存在显著差异，偏离了拟议的20/30/ 40%规则。在右肝切除术前，21%的应答者表示他们很少或从未使用体积测定法。扩大切除是最常使用体积测定法的外科手术。此外，动态生长速率在临床决策中并未被广泛采用。结论：本研究强调了FLR容积法的广泛应用，但也揭示了其应用的实质性变化。这表明缺乏关于适当使用FLR容积法的证据或指南。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Hpb GASTROENTEROLOGY & HEPATOLOGY-SURGERY

CiteScore

5.60

自引率

3.40%

发文量

244

审稿时长

57 days

期刊介绍： HPB is an international forum for clinical, scientific and educational communication. Twelve issues a year bring the reader leading articles, expert reviews, original articles, images, editorials, and reader correspondence encompassing all aspects of benign and malignant hepatobiliary disease and its management. HPB features relevant aspects of clinical and translational research and practice. Specific areas of interest include HPB diseases encountered globally by clinical practitioners in this specialist field of gastrointestinal surgery. The journal addresses the challenges faced in the management of cancer involving the liver, biliary system and pancreas. While surgical oncology represents a large part of HPB practice, submission of manuscripts relating to liver and pancreas transplantation, the treatment of benign conditions such as acute and chronic pancreatitis, and those relating to hepatobiliary infection and inflammation are also welcomed. There will be a focus on developing a multidisciplinary approach to diagnosis and treatment with endoscopic and laparoscopic approaches, radiological interventions and surgical techniques being strongly represented. HPB welcomes submission of manuscripts in all these areas and in scientific focused research that has clear clinical relevance to HPB surgical practice. HPB aims to help its readers - surgeons, physicians, radiologists and basic scientists - to develop their knowledge and practice. HPB will be of interest to specialists involved in the management of hepatobiliary and pancreatic disease however will also inform those working in related fields. Abstracted and Indexed in: MEDLINE® EMBASE PubMed Science Citation Index Expanded Academic Search (EBSCO) HPB is owned by the International Hepato-Pancreato-Biliary Association (IHPBA) and is also the official Journal of the American Hepato-Pancreato-Biliary Association (AHPBA), the Asian-Pacific Hepato Pancreatic Biliary Association (A-PHPBA) and the European-African Hepato-Pancreatic Biliary Association (E-AHPBA).