OBJECTIVE To assess the incidence of posthepatectomy liver failure (PHLF) and the role of the future liver remnant (FLR) in children undergoing major hepatectomy. SUMMARY BACKGROUND DATA Incidence and risk factors of PHLF in children are unclear, with no validated definition for this age group. Consequently, the role of the FLR in pediatric hepatectomy and evidence-based preoperative guidelines remain undefined. METHODS All pediatric patients undergoing major hepatectomy at a tertiary care center over a 10-year study period were analyzed. Preoperative imaging was used for volumetry. The incidence of PHLF was assessed applying predefined definitions, and the prognostic impact of the FLR on PHLF and complications was evaluated. RESULTS 125 children underwent major hepatectomy, including 35 trisectionectomies. There was a strong correlation between imaging-based measured total liver volume and calculated standard liver volume (r=0.728, P<0.001). The median total liver volume-to-body weight (BW) ratio was 3.4%, the median FLR/BW ratio was 1.5%. The median FLR-to-total liver volume ratio was 44% (range 18%-97%). No clinically relevant PHLF occurred. FLR/total liver volume and FLR/BW ratios had low predictive value for postoperative liver dysfunction and morbidity. CONCLUSION This is the largest reported single-center series of pediatric major hepatectomies. PHLF is exceedingly rare in children. The liver volume-to-body weight ratio is higher in children compared to adults, and the FLR is sufficient even in extreme resections with less than 20% of liver remnant. These findings strongly question the use of ALPPS, portal vein embolization, or transplantation based on suspected insufficient liver remnant in children.

中文翻译：

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太大而不能失败：125 例儿童主要肝切除术的体积分析和肝切除术后肝衰竭的发生率。


目的 评估肝切除术后肝衰竭 （PHLF） 的发生率及未来残余肝 （FLR） 在肝大切除术患儿中的作用。摘要 背景数据 儿童 PHLF 的发病率和危险因素尚不清楚，没有针对该年龄组的验证定义。因此，FLR 在儿科肝切除术中的作用和循证术前指南仍未明确。方法 分析了 10 年研究期间在三级医疗中心接受大肝切除术的所有儿科患者。术前影像学检查用于体积测定。采用预定义的定义评估 PHLF 的发生率，并评估 FLR 对 PHLF 和并发症的预后影响。结果 125 例患儿行大肝切除术，包括 35 例三切手术。基于影像学的测量总肝脏体积与计算的标准肝脏体积之间存在很强的相关性 （r=0.728，P<0.001）。肝脏总体积与体重 （BW） 的中位数为 3.4%，FLR/BW 的中位数为 1.5%。中位 FLR 与肝脏总体积比为 44% （范围 18%-97%）。未发生临床相关的 PHLF。FLR/总肝脏体积和 FLR/BW 比值对术后肝功能障碍和发病率的预测价值较低。结论 这是报道规模最大的儿科主要肝切除术单中心系列研究。PHLF 在儿童中极为罕见。与成人相比，儿童的肝脏体积与体重比更高，即使在残余肝脏少于 20% 的极端切除中，FLR 也足够。这些发现强烈质疑基于疑似儿童肝脏残留不足的 ALPPS 、门静脉栓塞术或移植的使用。