In the management of colorectal liver metastases (CRLM), the 'two-stage hepatectomy' with portal vein embolization (PVE) is used when future liver remnant (FLR) is insufficient. What is the MINIMUM acceptable FLR volume as a percentage of total functional liver volume to safely proceed with major hepatectomy in a previously healthy liver?
- A 20-25% ✓
- B 10-15%
- C 30-35%
- D 40-45%
Explanation
For patients with a normal, healthy liver (no chronic liver disease or chemotherapy-related injury), the minimum acceptable FLR is 20-25% of the total functional liver volume. This threshold is raised to 30-40% for patients with chronic liver disease (cirrhosis, significant fibrosis) and to 30% for those with extensive prior systemic chemotherapy who may have chemotherapy-associated steatohepatitis (CASH) or sinusoidal obstruction syndrome. Portal vein embolization (PVE) is performed when the FLR falls below these thresholds, inducing hypertrophy of the intended remnant over 4-6 weeks before major hepatectomy. ALPPS (Associating Liver Partition and Portal vein ligation for Staged hepatectomy) achieves faster but similar hypertrophy.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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