Abstract
BackgroundIn liver surgery, appropriate preoperative evaluation and preparation of the patient is of cardinal importance. The up-to-date, preoperative prediction of residual liver function has thus far been limited. As post-hepatectomy liver failure is a major cause of mortality, a new and simple bedside test (LiMAx) has been developed to predict postoperative liver function in conjunction with preoperative volumetric analysis of the liver.Case presentationA 45-year-old patient presented with a cecal carcinoma and a large synchronous liver metastasis for major liver surgery. Liver function was determined by the LiMAx-test for the enzymatic capacity of cytochrome P450 1A2, which is ubiquitously and solely active in the liver. A solution of 2 mg/kg body weight 13C-labeled methacetin was injected as a bolus into an intravenous catheter and, thereafter, was metabolized into acetaminophen and 13CO2 and pulmonarily exhaled. The analysis of the 13CO2/12CO2 ratio was performed using online breath sampling over a period of maximally 60 minutes. Based on this test, a value of more than 315 μg/kg/h represents normal liver function. A laparoscopic right hemihepatectomy was planned during virtual resection with a residual liver volume of 48% and a preoperative anticipated residual LiMAx of 301 μg/kg/h. After successful resection, the initial postoperative LiMAx value was 316 μg/kg/h, indicating good liver function and a correct prediction of the outcome.ConclusionIn the presented patient, residual liver function could be accurately predicted preoperatively using a combination of the new LiMax test with CT-volumetry. This test might significantly improve preoperative evaluation and postoperative outcomes in liver surgery.
Highlights
In liver surgery, appropriate preoperative evaluation and preparation of the patient is of cardinal importance
In the presented patient, residual liver function could be accurately predicted preoperatively using a combination of the new LiMax test with CT-volumetry
A laparoscopic left hemihepatectomy was planned during virtual resection with a functional resection of 895 mL, resulting in a residual liver volume of 841 mL (48%) and a pre-operatively anticipated residual LiMAx of 301 μg/kg/h (Figure 1)
Summary
Residual liver function could be accurately predicted preoperatively by the combination of the new LiMax test with CT-volumetry. Considering the existing literature, the LiMAx test significantly improves preoperative evaluation and postoperative outcomes in liver surgery. Competing interests The authors declare no conflicts of interest. The authors do not have any specific conflict of interest related to the manufacturer of the LiMAx test, including intellectual property, patents or patents pending, industrial relation to the manufacturer, or speaker’s honoraria. Authors’ contributions Data were prepared and reviewed by SAM, MC, CL and FP. The manuscript was drafted by SAM, IT and UB and critically edited by BMS. All authors read and approved the final manuscript. Author details 1Department of Surgery, Kantonsspital St.Gallen, St.Gallen, Switzerland. Author details 1Department of Surgery, Kantonsspital St.Gallen, St.Gallen, Switzerland. 2Institute of Radiology, Kantonsspital St.Gallen, St.Gallen, Switzerland. 3Rorschacherstrasse 95, 9007 St.Gallen, Switzerland
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