2009: Prediction of Postoperative Outcome After Hepatectomy With a New Bedside Test for Maximal Liver Function Capacity
Stockmann, M; Lock, JF; Riecke, B; Heyne, K; Martus, P; Fricke, M; Lehmann, S; Niehues, SM; Schwabe, M; Lemke, AJ; Neuhaus, P
ANNALS OF SURGERY 2009, 250(1), p. 119-125
Objective: To validate the LiMAx test, a new bedside test for the determination of maximal liver function capacity based on 13C-methacetin kinetics. To investigate the diagnostic performance of different liver function tests and scores including the LiMAx test for the prediction of postoperative outcome after hepatectomy.
Summary Background Data: Liver failure is a major cause of mortality after hepatectomy. Preoperative prediction of residual liver function has been limited so far.
Methods: Sixty-four patients undergoing hepatectomy were analyzed in a prospective observational study. Volumetric analysis of the liver was carried out using preoperative computed tomography and intraoperative measurements. Perioperative factors associated with morbidity and mortality were analyzed. Cutoff values of the LiMAx test were evaluated by receiver operating characteristic.
Results: Residual LiMAx demonstrated an excellent linear correlation with residual liver volume (r = 0.94, P < 0.001) after hepatectomy. The multivariate analysis revealed LiMAx on postoperative day I as the only predictor of liver failure (P = 0.003) and mortality (P = 0.004). AUROC for the prediction of liver failure and liver failure related death by the LiMAx test was both 0.99. Preoperative volume/function analysis combining CT volumetry and LiMAx allowed an accurate calculation of the remnant liver function capacity prior to surgery (r = 0.85, P < 0.001).
Conclusions: Residual liver function is the major factor influencing the outcome of patients after hepatectomy and can be predicted preoperatively by a combination of LiMAx and CT volumetry.