Maciej Malinowski1,2, Johan Friso Lock3, Daniel Seehofer3, Bernhard Gebauer4, Antje Schulz3,5, Lina Demirel3, Jan Bednarsch3, Victoria Stary3, Peter Neuhaus3, Martin Stockmann3. 1. Department of General, Visceral and Transplantation Surgery, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany. maciej.malinowski@uks.eu. 2. Department of General, Visceral, Vascular and Pediatric Surgery, University of Saarland, Kirrberger Straße 100, 66424, Homburg, Saarland, Germany. maciej.malinowski@uks.eu. 3. Department of General, Visceral and Transplantation Surgery, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany. 4. Department of Diagnostic and Interventional Radiology, Charité, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany. 5. Department of General, Visceral, Vascular and Pediatric Surgery, University of Saarland, Kirrberger Straße 100, 66424, Homburg, Saarland, Germany.
Abstract
PURPOSE: Post-hepatectomy liver failure (PHLF) is the major risk factor for mortality after hepatectomy. Preoperative planning of the future liver remnant volume reduces PHLF rates; however, future liver remnant function (FLR-F) might have an even stronger predictive value. In this preliminary study, we used a new method to calculate FLR-F by the LiMAx test and computer tomography-assisted volumetric-analysis to visualize liver function changes after portal vein embolization (PVE) before extended hepatectomy. METHODS: The subjects included patients undergoing extended right hepatectomy either directly (NO-PVE group) or after PVE (PVE group). Computed tomography (CT) scan and liver function tests (LiMAx) were done before PVE and preoperatively. FLR-F was calculated and correlated with the postoperative liver function. RESULTS: There were 12 patients in the NO-PVE group and 19 patients in the PVE group. FLR-F and postoperative liver function correlated significantly in both groups (p = 0.036, p = 0.011), although postoperative liver function was slightly overestimated, at 32 and 45 µg/kg/min, in the NO-PVE and PVE groups, respectively. LiMAx value did not change after PVE. CONCLUSIONS: Volume-function analysis using LiMAx and CT scan enables us to reliably predict early postoperative liver function. Global enzymatic liver function measured by the LiMAx test did not change after PVE, confirming that liver function distribution in the liver stays constant after PVE. An overestimation of FLR-F is needed to compensate for the intraoperative liver injury that occurs in patients undergoing extended hepatectomy.
PURPOSE: Post-hepatectomy liver failure (PHLF) is the major risk factor for mortality after hepatectomy. Preoperative planning of the future liver remnant volume reduces PHLF rates; however, future liver remnant function (FLR-F) might have an even stronger predictive value. In this preliminary study, we used a new method to calculate FLR-F by the LiMAx test and computer tomography-assisted volumetric-analysis to visualize liver function changes after portal vein embolization (PVE) before extended hepatectomy. METHODS: The subjects included patients undergoing extended right hepatectomy either directly (NO-PVE group) or after PVE (PVE group). Computed tomography (CT) scan and liver function tests (LiMAx) were done before PVE and preoperatively. FLR-F was calculated and correlated with the postoperative liver function. RESULTS: There were 12 patients in the NO-PVE group and 19 patients in the PVE group. FLR-F and postoperative liver function correlated significantly in both groups (p = 0.036, p = 0.011), although postoperative liver function was slightly overestimated, at 32 and 45 µg/kg/min, in the NO-PVE and PVE groups, respectively. LiMAx value did not change after PVE. CONCLUSIONS: Volume-function analysis using LiMAx and CT scan enables us to reliably predict early postoperative liver function. Global enzymatic liver function measured by the LiMAx test did not change after PVE, confirming that liver function distribution in the liver stays constant after PVE. An overestimation of FLR-F is needed to compensate for the intraoperative liver injury that occurs in patients undergoing extended hepatectomy.
Authors: Y Yumoto; T Yagi; S Sato; K Nouso; Y Kobayashi; M Ohmoto; E Yumoto; I Nagaya; H Nakatsukasa Journal: Br J Surg Date: 2010-06 Impact factor: 6.939
Authors: Georg Böning; Uli Fehrenbach; Timo Alexander Auer; Konrad Neumann; Martin Jonczyk; Johann Pratschke; Wenzel Schöning; Moritz Schmelzle; Bernhard Gebauer Journal: Cardiovasc Intervent Radiol Date: 2022-03-21 Impact factor: 2.797
Authors: M Stockmann; F W R Vondran; R Fahrner; H M Tautenhahn; J Mittler; H Bektas; M Malinowski; M Jara; I Klein; J F Lock Journal: BJS Open Date: 2018-06-14
Authors: Felix Oldhafer; Kristina I Ringe; Kai Timrott; Moritz Kleine; Wolf Ramackers; Sebastian Cammann; Mark D Jäger; Juergen Klempnauer; Hueseyin Bektas; Florian W R Vondran Journal: Patient Saf Surg Date: 2016-06-10