Background: Postoperative liver failure is the major cause of mortality and morbidity after partial liver resection, and develops as a result of insufficient remnant liver function. The aim of 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. Materials and Methods: ICG-test,methacetin breath test and 99mTc-technephyt hepatobiliary scintigraphy (HBS) were performed prior to major resection in 60 high-risk patients with liver tumors, including 15 patients with hepatocellular carcinoma. Liver function determined with HBS was compared with methacetin breath and ICG test by unified scale. Results: Passive liver function tests, including biochemical parameters and clinical grading systems, are not accurate enough in predicting outcome after liver surgery. Dynamic quantitative liver function tests such as the ICG test is more accurate as it measures the elimination process of a substance that is cleared and metabolized almost exclusively by the liver. However, this test only measure global liver function. Nuclear imaging techniques such as 99mTc-HBS can measure both total and future remnant liver function, and potentially identify patients at risk for postresectional liver failure. Meanwhile,13C-methacetin breath test measures the microsomal capacity of the liver. In fact, a strong positive association (r 0.73, p<0.01) was found between 13C-methacetin breath test determined with 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) Conclusions: As there is not one test that can measure all components of liver function, liver functional reserve remains to be estimated from combination of quantitative liver function tests. 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.
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