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Preliminary study on liver function changes after trisectionectomy with versus without prior portal vein

Maciej Malinowski1,2, Johan Friso Lock3, Daniel Seehofer3

  • 1Department of General, Visceral and Transplantation Surgery, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany. maciej.malinowski@uks.eu.

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Summary

Predicting post-hepatectomy liver failure is crucial. This study shows that combining LiMAx testing and CT scans to assess future liver remnant function (FLR-F) reliably predicts liver function after major liver surgery.

Keywords:
Extended hepatectomyFuture liver remnantPortal vein embolizationPostoperative liver failure

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Area of Science:

  • Hepatobiliary surgery
  • Surgical oncology
  • Liver transplantation

Background:

  • Post-hepatectomy liver failure (PHLF) is a significant cause of mortality following liver resection.
  • Accurate preoperative assessment of liver function is essential for minimizing PHLF risk.
  • While future liver remnant (FLR) volume is considered, FLR function (FLR-F) may offer superior predictive value.

Purpose of the Study:

  • To introduce and validate a novel method for calculating FLR-F using LiMAx testing and CT-assisted volumetry.
  • To assess changes in liver function after PVE and correlate FLR-F with postoperative liver function.
  • To evaluate the predictive accuracy of FLR-F for early postoperative liver function.

Main Methods:

  • Patients undergoing extended right hepatectomy were divided into direct resection (NO-PVE) and PVE groups.
  • CT scans and LiMAx tests were performed pre-PVE and preoperatively.
  • FLR-F was calculated and correlated with postoperative liver function outcomes.

Main Results:

  • A significant correlation was observed between FLR-F and postoperative liver function in both NO-PVE and PVE groups (p=0.036, p=0.011).
  • Postoperative liver function was slightly overestimated (32 and 45 µg/kg/min in NO-PVE and PVE groups, respectively).
  • LiMAx values remained unchanged post-PVE, indicating stable global liver function.

Conclusions:

  • Volume-function analysis integrating LiMAx and CT accurately predicts early postoperative liver function.
  • LiMAx test confirms stable global liver function post-PVE, suggesting consistent liver function distribution.
  • A slight overestimation of FLR-F is recommended to account for anticipated intraoperative liver injury.