Evaluation of liver function for hepatic resection

Area of Science:

• Hepatology
• Surgical Oncology
• Diagnostic Imaging

Background:

• Liver resection requires accurate assessment of functional hepatic reserve to minimize mortality and morbidity.
• Existing methods like the Child-Pugh score have limitations in predicting post-hepatectomy liver failure.
• Several laboratory and imaging techniques are used to assess liver function, but a definitive test is lacking.

Purpose of the Study:

• To evaluate methods for predicting liver failure after liver resection.
• To identify reliable indicators of functional hepatic reserve in patients undergoing hepatectomy.
• To establish new limits and guidelines for managing patients undergoing liver resection.

Main Methods:

• Review of laboratory data and imaging techniques, including aminopyrine breath test, galactosyl elimination capacity, and indocyanine green retention test (ICG R15).
• Assessment of nuclear imaging of asialoglycoprotein receptors for volumetric and functional evaluation.
• Combination of Child-Pugh score, ascites, serum bilirubin, ICG R15, and remnant liver CT volumetry.

Main Results:

• Aminopyrine breath test and galactosyl elimination capacity are decreased in hepatic failure post-resection but absence does not exclude it.
• Indocyanine green retention test (ICG R15) is widely used but imperfect, influenced by hepatic blood flow and liver function.
• Nuclear imaging offers volumetric and functional assessment.
• A combination of Child-Pugh score, ascites, bilirubin, ICG R15, and CT volumetry appears promising for predicting liver failure.

Conclusions:

• Accurate assessment of functional hepatic reserve after liver resection is crucial but complex.
• The indocyanine green retention test (ICG R15) is a valuable tool, with values above 15% suggesting the need for portal vein embolization.
• If ICG clearance testing is not feasible, alternative dynamic liver function tests can be utilized.