A 45-year-old woman with colorectal cancer metastatic to the liver is evaluated for hepatic resection. Which of the following is the MOST important contraindication to resection?
- A More than 4 hepatic metastases
- B Metachronous presentation of hepatic metastases (>1 year from primary)
- C Insufficient future liver remnant (FLR) — predicted remnant volume <25-30% in otherwise normal liver ✓
- D Bilobar distribution of metastases
Correct answer: C. Insufficient future liver remnant (FLR) — predicted remnant volume <25-30% in otherwise normal liver
Explanation
The most critical contraindication to hepatic resection for colorectal liver metastases is inadequate future liver remnant (FLR). For patients with a normal liver, FLR <25-30% is associated with post-hepatectomy liver failure. The number of metastases (>4), bilobar involvement, and synchronous presentation are no longer absolute contraindications if clear margins can be achieved and FLR is adequate. Portal vein embolisation can be used to hypertrophy the FLR before extended resections.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.