Which is the limit for laparoscopic hepatectomies?

Abstract

Aims: Preoperative prediction of postoperative future liver remnant volume (FLRV) is considered as state of the art in risk evaluation in patients undergoing extended partial liver resection. However, in case of liver disease, e.g. cirrhosis, NASH or preoperative chemotherapy, a simple volume calculation is insufficient since actual liver function is deteriorated in those patients. In the presented results, we did evaluate the feasibility of predicting postoperative future liver remnant function (FLRF) in patients undergoing major hepatectomy. Methods: Data was acquired in a prospective clinical study. Preoperative liver function was assessed by the enzymatic based 13C-breath test LiMAx. FRLV was estimated using a 3-dimensional volumetric analysis of a preoperative 4-phase CT-scan in close cooperation with the attending liver surgeon. FRLF was calculated on the basis of preoperative liver function and FRLV. Directly after the operation (1e4 hours) all patients received an additional CT-scan as well as LiMAx test. The actual postoperative liver function was compared to the preoperative predicted function (FRLF). Results: A number of 28 patients have been enrolled in this study. Predicted FRLV correlates with the measured postoperative liver volume (r = 0.95, p < .001). The actual postoperative measured liver function by LiMAx also showed a good correlation with the predicted FRLF (r = 0.89, p < .001). Mean LiMAx difference between estimated and measured function was À33 g/h/kg. Conclusions: Volume/function analysis for FRLF using the LiMAx test and virtual liver resection with 3D-CT can accurately predict residual liver function and therefore could improve the preoperative planning. Since postoperative liver function assessed by LiMAx has proven to be an excellent predictor of postoperative morbidity and mortality, preoperative prediction of FRLF has the potential to decrease the rate of postoperative liver failure and major complications.