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Future Liver Remnant — SCE Medical Oncology MCQ

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HardGI CancersFuture Liver RemnantSCE Medical Oncology

A 65-year-old man with colorectal cancer liver metastases has a response to FOLFOX + bevacizumab such that the lesions are now considered resectable. Pre-operative assessment includes a CT volumetry showing a future liver remnant (FLR) of only 22% of total liver volume. What is the minimum safe FLR?

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Correct answer: B — FLR must be ≥20% in normal liver (≥30% after chemotherapy or ≥40% in cirrhotic liver) — his 22% is borderline after chemotherapy and portal vein embolisation may be needed to increase FLR

Adequate FLR is critical for preventing post-hepatectomy liver failure. Minimum safe FLR varies by liver quality: ≥20% for normal liver, ≥30% for chemotherapy-damaged liver (steatosis, sinusoidal injury), and ≥40% for cirrhotic liver. When FLR is insufficient, portal vein embolisation (PVE) or associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) can hypertrophy the FLR over 4-6 weeks before surgery.

Reference: ESMO 2024 mCRC Guidelines; NICE NG151; Vauthey et al Surgery 2000