"State of the Art" in Liver Resection and Living Donor Liver Transplantation: A Worldwide Survey of 100 Liver Centers

New strategies have been developed to expand indications for liver surgery. The objective was to evaluate the current practice worldwide regarding critical liver mass and manipulation of the liver volume. A survey was sent to 133 liver centers worldwide, which focused on (a) critical liver volume, (b) preoperative manipulation of the liver mass, and (c) use of liver biopsy and metabolic tests. The overall response rate to the survey was 75%. Half of the centers performed more than 100 resections per year; 86% had an associated liver transplant program. The minimal remnant liver volume for resection was 25% (15-40%) in cases of normal liver parenchyma and 50% (25-90%) in the presence of underlying cirrhosis. The minimal remnant liver volume for living donors was 40% (30-50%), whereas the accepted graft body weight ratio was 0.8 (0.6-1.2). Portal vein occlusion to manipulate the liver volume before resection was performed in 89% of the centers. Limits of liver volume and the current practice of liver manipulation before resection were comparable among different centers and continents. The minimal remnant liver volume in normal liver was 25%, and more than 80% of the centers performed portal vein occlusion.