Background: The aim of this study was to evaluate serial changes in liver v
olume after major hepatectomy for biliary cancer and to elucidate clinical
factors influencing liver regeneration.
Methods: Serial changes in liver volume were determined, using computed tom
ography, in 81 patients with biliary cancer who underwent right hepatic lob
ectomy or more extensive liver resection with or without portal vein resect
ion and/or pancreatoduodenectomy. Possible factors influencing liver regene
ration were evaluated by univariate and multivariate analyses.
Results: The remnant mean(s.d.) liver volume was 41(8) per cent straight af
ter hepatectomy. This increased rapidly to 59(9) per cent within 2 weeks, t
hen increased more slowly, finally reaching a plateau at 74(12) per cent ab
out 1 year after hepatectomy. The regeneration rate within the first 2 week
s was 16(8) cm(3)/day and was not related to the extent of posthepatectomy
liver dysfunction. On multivariate analysis, the extent of liver resection
(P < 0.001), body surface area (P = 0.02), combined portal vein resection (
P = 0.024) and preoperative portal vein embolization (P = 0.047) were signi
ficantly associated with the liver regeneration rate within the first 2 wee
ks. In addition, body surface area (P < 0.001) and liver function expressed
as plasma clearance rate of indocyanine green (P = 0.01) were significant
determinants of final liver volume 1 year after hepatectomy.
Conclusion: The liver regenerates rapidly in the first 2 weeks after major
hepatectomy for biliary cancer. This early regeneration is influenced by fo
ur clinical factors. Thereafter, liver regeneration progresses slowly and s
tops when the liver is three-quarters of its original volume, approximately
6 months to 1 year after hepatectomy.