Reducing mortality in liver surgery by introduction of the dynamic liver function test LiMAx

M Stockmann,J Bednarsch,M Jara,M Malinowski,S Gebhardt,D Seehofer,J Pratschke

doi:10.1016/j.hpb.2016.01.501

M Stockmann, J Bednarsch + Show 5 more

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https://doi.org/10.1016/j.hpb.2016.01.501

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Journal: HPB	Publication Date: Apr 1, 2016
License type: publisher-specific-oa

Affiliation: Charité - Universitätsmedizin Berlin

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Aims: The LiMAx-Algorithm – a clinical decision tree based on the preoperative prediction of actual postoperative liver function with the dynamic liver function test LiMAx – was introduced 2008/9 in our high volume liver center succeeding conventional CT-scan based volume planning as standard tool for risk evaluation in patients undergoing partial liver resection. We hereby report the impact of the new standard procedure on postoperative outcome in patients undergoing partial liver resection. Methods: All patients undergoing liver resection of at least one segment between the years 2006 to 2011 (n = 1170) were analyzed for this retrospective study. Primary case data were retrieved from the administrative medical controlling department. Clinical characteristics, operative data and postoperative outcome were compared between the years. Additionally a propensity score based matched analysis of the years 2006/2007 (n = 313) to 2010/2011 (n = 313) was carried out. Results: While the amount patients undergoing partial liver resection in cirrhosis (p = 0.039) and the proportion of complex partial liver resection (p = 0.034) significantly increased within the years, the rate of post hepatectomy liver failure (p < 0.001) and liver related death (p = 0.014) decreased significantly. The matched pair analysis between 2006/2007 and 2010/2011 showed no difference regarding age, ASA score and surgical procedure between the groups. However the comparison yielded a significant decline in postoperative liver dysfunction from 24.7 % to 11.2 % (p < 0.001) and liver related death from 3.8% to 1.0% (p = 0.035). Conclusions: The rate of postoperative liver failure and liver failure related death could be reduced significantly due to the introduction of the dynamic liver function test LiMAx in our high volume liver center. The LiMAx-Algorithm is capable to evaluate risks of complex surgical procedures making partial liver resection safer.

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