Volumetric analysis and indocyanine green retention rate at 15 min as predictors of post‐hepatectomy liver failure

Abstract Objectives The actual future liver remnant (aFLR) is calculated as the ratio of remnant liver volume (RLV) to total functional liver volume (TFLV). The standardized future liver remnant (sFLR) is calculated as the ratio of RLV to standard liver volume (SLV). The aims of this study were to compare the aFLR with the sFLR and to determine criteria for safe hepatectomy using computed tomography volumetry and indocyanine green retention rate at 15 min (ICG R15). Methods Medical records and volumetric measurements were obtained retrospectively for 81 patients who underwent right hemi‐hepatectomy for malignant hepatic tumours from January 2010 to November 2013. The sFLR was compared with the aFLR, and a ratio of sFLR to ICG R15 as a predictor of postoperative hepatic function was established. Results In patients without cirrhosis, the sFLR showed a stronger correlation with the total serum bilirubin level than the aFLR ( R 2 = 0.499 versus R 2 = 0.239). Post‐hepatectomy liver failure developed only in the group with an sFLR of 1.9 showed 66.7% sensitivity and 100% specificity. Conclusions Regardless of ICG R15, an sFLR of ≥25% in patients without cirrhosis, and an sFLR of ≥25% with an sFLR : ICG R15 ratio of >1.9 in patients with cirrhosis indicate acceptable levels of safety in major hepatectomy.