The role of functional liver tests in liver cancer surgery

Abstract

Background: The aim of this study was to sum up our experience on the most clinically relevant and novel liver function tests used for the assessment of hepatic function before liver surgery with the ultimate goal to design a method to identify patients at risk of liver failure (and hence mortality) following liver resection. Methods: ICG-test, methacetin breath test and 99mTc-technephyt hepatobiliary scintigraphy (HBS) were performed prior to major resection in 30 high-risk patients with primary and metastatic liver tumors. Liver function determined with HBS was compared with 13C-methacetin breath and ICG test by unified scale. Results: ICG test is more accurate as it measures the elimination process of a substance that is cleared and metabolized all most exclusively by the liver. Nuclear imaging techniques such as 99mTc-technephyt HBS can measure both total and FLR function. 13C-methacetin breath test measures the microsomal capacity of the liver. A strong positive association (r 0.73, p<0.01) was found between 13C-methacetin test determined with 99mTc-technephyt HBS, a positive moderate uphill relationship between results of ICG & breath test (r 0.53, p<0.01) and ICG& HBS(r 0.6, p<0.01). Conclusion: Presently, combination of 99mTc- technephyt HBS, ICG and 13C-methacetin breath test seems to be the most valuable liver function estimate, as its can measure multiple aspects of liver function in specifically the future remnant liver.