Here is my editorial highlight from the May issue of HPB the official journal of the IHPBA, AHPBA, E-AHPBA.
The technology used to measure liver volume continues to improve and with it our understanding of liver anatomy in relation to surgery. In this month’s issue of HPB, Kokudo’s group from Tokyo present an analysis of single segment volumes of the livers of more than 100 patients. This detailed analysis was performed based on portal perfusion patterns to define segmental anatomy. The authors have produced a volume ‘road map’ of the liver demonstrating typical segmental volumes for each of the eight liver segments. On the face of it this information is extremely valuable for the surgeon, however, what this study also shows is the very major variation in segmental volumes that occur between different patients. An example of this is given by the data for segment VIII. This segment had the largest mean volume of functional liver accounting for on average 26% of total liver volume (TLV), however this ranged between individual patients from only 11% to as much as 38% of TLV. The message here is that individual patient assessment remains critical to pre-operative planning. Among the liver surgical community opinion is divided over how much anatomical planning is required in patients. There are clearly patients who may have precarious liver function or difficultly placed tumours where careful anatomical staging and volume analysis are imperative to successful outcome. Equally there are many others where standard anatomical resection is unlikely to compromise either resection margins or functional capacity of the liver. In those cases where planning is required, measurement of portal perfusion territories seems to offer the best basis for anatomical staging and volume assessment.