How can we predict hepatic insufficiency after resection of colorectal liver metastases?

We read with highest interest the paper recently published in the Journal of Hepatology entitled “Hepatic atrophy following preoperative chemotherapy predicts hepatic insufficiency after resection of colorectal liver metastases (CLM)” written by Yamashita et al. from the MD Anderson Cancer Center (1). They reported with clear and definite clinical data from very large cohort (n=459) that hepatic atrophy ≥10% evaluated by multidetector row enhanced computed tomography (CT) following preoperative chemotherapy can predict postoperative hepatic insufficiency (PHI) after resection of CLM. We honor their major and long-lasting contributions to the prediction or prevention of PHI after resection for CLM (2-5). Not only is PHI a major cause of postoperative mortality after the resection of CLM, but postoperative morbidities including PHI have negative impacts on patients’ survival after resection of CLM (6-8). While their work is clear and definite, I think there are several points that should be discussed. We would like to address those points in this “Editorial”, and discuss how we can predict PHI after the resection of CLM.