Postoperative liver dysfunction and future remnant liver: Where is the limit? Results of a prospective study

Background: The future remnant liver (FRL) limit for safe major hepatectomy with low risk of postoperative liver failure has not yet been well defined. Methods: Between April 2000 and September 2004, every patient scheduled for major hepatectomy in our institution underwent CT-volumetry of FRL. Patients with FRL 2 mg/100 ml) (group B). Liver dysfunction was defined as both PT 5 mg/100 ml for three or more consecutive days. Results: A total of 119 patients were analyzed, 72 in group A and 47 in group B. The FRL value was the only significant risk factor for postoperative liver dysfunction in the univariate and multivariate analysis (p = 0.009). The FRL did not correlate with postoperative mortality and morbidity. Bilirubin and prothrombin time (PT) on days 3 and 7 were significantly correlated to FRL in both groups. In group A, patients with postoperative liver dysfunction had a FRL26.5% in patients with healthy liver and >31% in patients with impaired liver function.