A study of rate of volumetric regeneration of liver after liver resection and its correlation with platelets and synthetic liver function tests: a single tertiary care centre experience

Sirisha Komala, A. K. Sharma, Vikram Trehan


Background: Aim of our study was to evaluate the impact of pre and postoperative platelet counts and synthetic liver function tests on liver regeneration and its correlation with CT volumetry in patients undergoing liver resections with curative intent.

Methods: All major and minor liver resections (maximum 30) between July 2016 and May 2019 at our hospital were included in the study according to the inclusion criteria and patients who had data available on preoperative, 2 weeks and 2 months postoperative platelet counts, synthetic liver function tests as well as triple phase CECT images, were identified retrospectively and these tests will be done for patients who are included prospectively.

Results: The rate of regeneration expressed as % RFLR is proportional to the extent of resection. It was less than 20% in WLE and less than 100% in left lobe resections and 100 to 300% in patients undergoing right hepatectomies and extended right hepatectomies. There was no statistically significant effect of sex, age, BMI, serum albumin, platelet count, INR, preoperative chemotherapy and presence of cirrhosis on percentage of regeneration as well as rate of regeneration. However, perioperative low serum albumin and platelet count had statistically significant effect on mortality (p<0.001).

Conclusions: We conclude that; greater the extent of liver resection, faster is the rate of regeneration. Perioperative low serum albumin and platelet counts have significant effect on mortality.


Volumetric regeneration, Liver resection, Liver function test, Hepatectomies, Platelet count

Full Text:



Lopes-Junior AG, Belebecha V, Jacob CE. Hepatectomy: a critical analysis on expansion of the indications. Arq Bras Cir Dig. 2014;27(1):47-52.

Vibha V, Naimish M, Vinay K, Nundy S. Indications and contraindications for liver transplantation. Int J Hepatol. 2011;9:121-4.

Lesurtel M, Nagorney DM, Mazzaferro V, Jensen RT, Poston GJ. When should a liver resection be performed in patients with liver metastases from neuroendocrine tumours? A systematic review with practice recommendations. HPB (Oxford). 2014;17(1):17-22.

Zhang W, Huang ZY, Ke CS. Surgical treatment of giant liver hemangioma larger than 10 cm: a single center's experience with 86 patients. Medicine (Baltimore). 2015;94(34):e1420.

Ouyang G, Liu J, Wang P, Ren Y, Yi P, Zhou Q. Multiple factors affect the regeneration of liver. Rev Assoc Med Bras. 2018;64(9):791-8.

Michalopoulos GK. Liver regeneration after partial hepatectomy: critical analysis of mechanistic dilemmas. Am J Pathol. 2010;176(1):2-13.

Lisman T, Porte RJ. Mechanisms of platelet-mediated liver regeneration. Blood. 2012;128(5);625-9.

Kurokawa T, Ohkohchi N. Platelets in liver disease, cancer and regeneration. World J Gastroenterol. 2017; 23(18):3228-39.

Michalopoulos GK. Liver regeneration. J Cell Physiol. 2007;213(2):286-300.

Payam S, Pahlavan REF, Christos Z, Jannis KP. Challenge: molecular, cellular and systemic aspects of liver regeneration. J Surg Res. 2006;134(2):238-51.

Porte RJ, Lisman T. Mechanisms of platelet-mediated liver regeneration. Blood. 2016;128(5):625-9.

Ren Y. Liver regeneration. J Cell Physiol. 2010; 213(2):159-165.

Aragon RJ, Solomon NL. Techniques of hepatic resection. J Gastrointest Oncol. 2012;3(1):28-40.

Goja S, Yadav SK, Yadav A. Accuracy of preoperative CT liver volumetry in living donor hepatectomy and its clinical implications. Hepatobiliary Surg Nutr. 2018;7(3):167-74.

Jeong WK. Clinical implication of hepatic volumetry for living donor liver transplantation. Clin Mol Hepatol. 2018;24(1):51-3.

Kenji S, Mark L, Epstein K. Quantitative radiology: automated ct liver volumetry compared with interactive volumetry and manual volumetry. Am J of Roentol. 2011;197(4):W706-12.

Strasberg SM, Phillips C et al. Use and dissemination of the Brisbane 2000 nomenclature of liver anatomy and resections. Ann Surg. 2013;257:377.

Guglielmi A, Ruzzenente A, Conci S, Valdegamberi A, Iacono C, et al. How much remnant is enough in liver resection? Dig Surg. 2012;29(1):6-17.

Goja S, Yadav SK, Yadav A. Accuracy of preoperative CT liver volumetry in living donor hepatectomy and its clinical implications. Hepatobiliary Surg Nutr. 2018;7(3):167-74.

Jeong WK. Clinical implication of hepatic volumetry for living donor liver transplantation. Clin Mol Hepatol. 2018;24(1):51-3.

Karlo C, Reiner CS, Stolzmann P, Breitenstein S, Marincek B, Weishaupt D, et al. CT- and MRI-based volumetry of resected liver specimen: comparison to intraoperative volume and weight measurements and calculation of conversion factors. Eur J Radiol. 2010; 75(1): e107-11.

Margonis GA, Amini N, Buettner S, Besharati S, Kim Y, Sobhani F, et al. Impact of early postoperative platelet count on volumetric liver gain and perioperative outcomes after major liver resection. Br J Surg. 2016;103:899-907.

MitznerS, Klammt S, Stange J, Schmidt R. Albumin regeneration in liver support-comparison of different methods.TherApher Dial. 2006;10(2):108-17.

Ibis C, Asenov Y, Akin M, Azamat IF, Sivrikoz N, Gurtekin B et al. Factors Affecting Liver Regeneration in Living Donors After Hepatectomy. Med Sci Monit. 2017;23:5986-93.

Itoh S, Shirabe K, Taketomi A. Zero mortality in more than 300 hepatic resections: validity of preoperative volumetric analysis. Surg Today. 2012;42(5):435-40.

Lee J, Kim KW, Kim SY. Feasibility of semiautomated MR volumetry using gadoxetic acid-enhanced MRI at hepatobiliary phase for living liver donors. Magn Reson Med. 2014;72(3):640-5.

Zappa M, Dondero F, Sibert A, Vullierme MP, Belghiti J, Vilgrain V, et al. Liver regeneration at day 7 after right hepatectomy: global and segmental volumetric analysis by using CT. Radiology. 2009; 252:426-32.

Ulla M, Ardiles V, Levy-Yeyati E, Alvarez FA, Spina JC, Garcia-Mónaco RD, De Santibañes Eetal. New surgical strategy to induce liver hypertrophy: role of MDCT-volumetry to monitor and predict liver growth. Hepatogastroenterology. 2013;60:337-42.