Total and segmental liver volume variations: Implications for liver surgery

Background. Liver remnant volumes after major hepatic resection and graft volumes for liver transplantation correlate with surgical outcome. The relative contributions of the hepatic segments to total liver volume (TLV) are not well established. Methods. TLV and hepatic segment volumes were measured with computed tomography (CT) in 102 patients without liver disease who underwent CT for conditions unrelated to the liver or biliary tree. Results. TLV ranged from 911 to 2729 cm(3). On average, the right liver (segments V, VI, VII, and VIII) contributed approximately two thirds of TLV (997 279 Cm), and the left liver (segments II, III and TV) contributed approximately one third of TLV(493 +/- 127 cm(3)). Bisegment II+III (left lateral section) contributed about half the volume of the left liver (242 +/- 79 cm(3)), or 16% of TLV Liver volumes varied significantly between patients-the right liver varied from 49% to 82% of TLV, the left liver, 17% to 49% of TLV, and bisegment II+III (left lateral section) 5% to 27% of TLV Bisegment II+III contributed less than 20% of TLV in more than 75% of patients and the left liver contributed 25% or less of TLV in more than 10% of patients. Discussion. There is clinically significant interpatient variation in hepatic volumes. Therefore, in the absence of appreciable hypertrophy, we recommend routine measurement of the future liver remnant before extended Tight hepatectomy (fight trisectionectomy) and in selected patients before Tight hepatectomy if a small left liver is anticipated.