A randomized controlled trial for enhanced recovery in liver surgery: improved perioperative management using the LiMAx test

Abstract

Background: The LiMAx test can validly determine liver maximal capacity and has been successfully integrated in clinical management in liver surgery. However, no prospective randomized trials have been available to judge its actual clinical impact. Methods: A randomized controlled trial (RCT) was conducted from January 2013 to September 2015 in six recruiting hospitals. Patients prior open liver resection of at least one segment were included. Patients were randomly assigned to LiMAx group (pre-, and postoperative LiMAx test) or control group (standard-of-care). Stable patients with sufficient residual liver function (LiMAx >150 μg/kg/h) were directly transferred to general ward after surgery. Results: A total of 148 patients were randomized. Patients in LiMAx group were more frequently directly transferred to general ward after surgery (62.1% vs. 1.7%; p<0.0001), the risk of severe postoperative complications was lower (≥ grade IIIa; 14% vs. 28%; p<0.02) and the length of post-operative stay was shorter (10 vs. 13 days; p=0.01). No patient in LiMAx group was admitted to intensive care after primary transfer to general ward. Conclusion: The LiMAx test distinctively improves perioperative management in liver surgery. The valid identification of low risk patients skipping intensive care enables enhanced recovery.