Abstract
The aim of this study was to investigate the utility of the phenacetin metabolism test in evaluating hepatic reserve function prior to hepatectomy for the prevention of postoperative liver dysfunction. Fifty-six patients with hepatocellular carcinoma had undergone hepatectomy. Patients were classified into group I (normal group, n = 37) and group II (with peak total bilirubin >53.8 μmol/L for 7 days after hepatectomy, n = 19) based on the levels of total bilirubin after hepatectomy. The receiver operating characteristic (ROC) analysis was made to assess the hepatic reserve function to predict liver dysfunction of the patients after hepatectomy. Hepatic reserve function was evaluated by phenacetin metabolism test; the ratio of plasma total paracetamol to phenacetin at 2 h after oral 1.0 g phenacetin. There were no significant differences in preoperative variables or intraoperative findings except the ratio of plasma total paracetamol to phenacetin. ROC analysis showed that the sensitivity and specificity of the ratio of plasma total paracetamol to phenacetin ≤1.2 were 85.4 and 72.9%, respectively for predicting liver dysfunction of the patients after hepatectomy. The ratio of plasma total paracetamol to phenacetin correlated with the temporary postoperative liver dysfunction (P = 0.008). Phenacetin metabolism test before hepatectomy appears to provide direct and reliable measure of hepatic reserve function, thus helping in surgical decision making regarding the extent of hepatectomy and in the prevention of the occurrence of postoperative liver dysfunction. Key words: Phenacetin metabolism test, hepatic reserve function, hepatectomy, liver Dysfunction
Highlights
Less than 30% of the patients used in this study are eligible for liver resection, either due to tumor multifocality or severity of their underlying liver disease, surgery remains the most effective treatment in patients with hepatocellular carcinoma (HCC) (Schwartz et al, 2007; Llovet et al, 2005)
Of all the patients that recovered from temporary postoperative liver dysfunction, none of them died of liver failure
There were no differences in age, Child-Pugh score, model of end-stage liver disease (MELD) score, prothrombin time-international normalized ratio, total bilirubin (TB), albumin (ALB), alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), gamma-glutamyl transferase (GGT), and total liver volume (TLV) between the two groups (P > 0.05), but phenacetin test variables, the ratio of plasma total paracetamol to phenacetin, showed significant differences between group I and group II (P = 0.009; Table 1)
Summary
Less than 30% of the patients used in this study are eligible for liver resection, either due to tumor multifocality or severity of their underlying liver disease, surgery remains the most effective treatment in patients with hepatocellular carcinoma (HCC) (Schwartz et al, 2007; Llovet et al, 2005). The function of the underlying liver clearly plays an important role in the early postoperative outcome. Hepatic reserve function is the most crucial factor to consider in planning the extent of hepatic resection (Mullin et al, 2005). Precise evaluation is important before resection for hepatoma, because almost all the patients are infected with hepatitis B or C virus and have chronic liver disease. Child–Pugh score has been the traditional gold standards for assessment of hepatic reserve function since 1973 (Pugh et al, 1973), but appears to be sensitive to
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