Abstract
The risk of poor post-operative outcome and the benefits of surgical resection as a curative therapy require careful assessment by the clinical care team for patients with primary and secondary liver cancer. Advances in surgical techniques have improved patient outcomes but identifying which individual patients are at greatest risk of poor post-operative liver performance remains a challenge. Here we report results from a multicentre observational clinical trial (ClinicalTrials.gov NCT03213314) which aimed to inform personalised pre-operative risk assessment in liver cancer surgery by evaluating liver health using quantitative multiparametric magnetic resonance imaging (MRI). We combined estimation of future liver remnant (FLR) volume with corrected T1 (cT1) of the liver parenchyma as a representation of liver health in 143 patients prior to treatment. Patients with an elevated preoperative liver cT1, indicative of fibroinflammation, had a longer post-operative hospital stay compared to those with a cT1 within the normal range (6.5 vs 5 days; p = 0.0053). A composite score combining FLR and cT1 predicted poor liver performance in the 5 days immediately following surgery (AUROC = 0.78). Furthermore, this composite score correlated with the regenerative performance of the liver in the 3 months following resection. This study highlights the utility of quantitative MRI for identifying patients at increased risk of poor post-operative liver performance and a longer stay in hospital. This approach has the potential to inform the assessment of individualised patient risk as part of the clinical decision-making process for liver cancer surgery.
Highlights
Liver resection for primary and secondary malignant tumours is a fundamental component of the multimodal treatment of cancer [1, 2]
The large majority (n = 114, 84% of participants) had liver metastases from colorectal cancer; the remainder had hepatocellular carcinoma (n = 6), cholangiocarcinoma (n = 1) or other metastases (n = 14) including breast cancer metastasis and ovarian cancer metastasis. 73 patients had received systemic anticancer chemotherapy that was ended a median of 56 days prior to surgery. 12 patients presented with a diagnosed underlying liver disease
MpMRI was performed in all patients and 21% of individuals (29/135) had pre-operative liver corrected T1 (cT1) values greater than the upper limit of normal (795 ms) defined for the general population [34, 35]
Summary
Liver resection for primary and secondary malignant tumours is a fundamental component of the multimodal treatment of cancer [1, 2]. When an individual patient and multidisciplinary surgical team is considering liver resection, a major challenge is knowing in advance whether liver surgery will be survivable and how that individual’s liver will recover function after surgery [3]. We term this future liver performance (FLP), and misjudging FLP can result in postsurgical liver failure and death [4]. FLR volume is typically straightforward to calculate from routine pre-operative imaging with computed tomography (CT) or magnetic resonance imaging (MRI) [5] This requires substantial time input from specialised radiologists [5] using dedicated software tools to accurately delineate the planned FLR
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