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Published in: Langenbeck's Archives of Surgery 8/2012

01-12-2012 | Original Article

Function and volume recovery after partial hepatectomy: influence of preoperative liver function, residual liver volume, and obesity

Authors: Johan Friso Lock, Maciej Malinowski, Daniel Seehofer, Steffi Hoppe, Rhea Isabel Röhl, Stefan Markus Niehues, Peter Neuhaus, Martin Stockmann

Published in: Langenbeck's Archives of Surgery | Issue 8/2012

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Abstract

Background

The regenerative capacity of the liver is an essential pre-condition for the successful application of partial hepatectomy. However, the actual kinetics of functional recovery remains unspecified and no adequate tool for its clinical monitoring has yet been available.

Methods

Eighty-five patients receiving major hepatectomy were investigated from the preoperative evaluation until 12 weeks after surgery. Liver function was determined by the LiMAx test for the enzymatic capacity of cytochrome P450 1A2. Liver volume was determined by volumetric analysis of repeated computer tomography scans. Functional and volume recovery were compared during follow-up.

Results

Major hepatectomy decreased liver function capacity to 35.7 ± 13.8 % of preoperative function. It was shown that functional recovery already reaches 77.2 ± 33.5 % of preoperative values within 10 days. The actual kinetics were dependent from the type and extent of hepatectomy. Complete functional restoration was achieved within 12 weeks, while liver volume still remained at 73.2 ± 14.8 % of preoperative. A constant but interindividually variable correlation between function and volume was observed at all points in time.

Conclusion

Partial hepatectomy leads to fast and complete functional recovery, while volume recovery is delayed and remains often incomplete. The functional recovery is mainly influenced by the preoperative liver function, the residual liver volume, and by obesity.
Literature
1.
go back to reference Lee SG, Hwang S (2005) How I do it: assessment of hepatic functional reserve for indication of hepatic resection. J Hepatobiliary Pancreat Surg 12(1):38–43PubMedCrossRef Lee SG, Hwang S (2005) How I do it: assessment of hepatic functional reserve for indication of hepatic resection. J Hepatobiliary Pancreat Surg 12(1):38–43PubMedCrossRef
2.
3.
go back to reference Lock JF, Reinhold T, Malinowski M, Pratschke J, Neuhaus P, Stockmann M (2009) The costs of postoperative liver failure and the economic impact of liver function capacity after extended liver resection-a single-center experience. Langenbecks Arch Surg 394(6):1047–1056PubMedCrossRef Lock JF, Reinhold T, Malinowski M, Pratschke J, Neuhaus P, Stockmann M (2009) The costs of postoperative liver failure and the economic impact of liver function capacity after extended liver resection-a single-center experience. Langenbecks Arch Surg 394(6):1047–1056PubMedCrossRef
4.
go back to reference van den Broek MA, Olde Damink SW, Dejong CH, Lang H, Malago M, Jalan R, Saner FH (2008) Liver failure after partial hepatic resection: definition, pathophysiology, risk factors and treatment. Liver Int 28(6):767–780PubMedCrossRef van den Broek MA, Olde Damink SW, Dejong CH, Lang H, Malago M, Jalan R, Saner FH (2008) Liver failure after partial hepatic resection: definition, pathophysiology, risk factors and treatment. Liver Int 28(6):767–780PubMedCrossRef
5.
go back to reference Stockmann M, Lock JF, Riecke B, Heyne K, Martus P, Fricke M, Lehmann S, Niehues SM, Schwabe M, Lemke A-J et al (2009) Prediction of postoperative outcome after hepatectomy with a new bedside test for maximal liver function capacity. Ann Surg 250(1):119–125PubMedCrossRef Stockmann M, Lock JF, Riecke B, Heyne K, Martus P, Fricke M, Lehmann S, Niehues SM, Schwabe M, Lemke A-J et al (2009) Prediction of postoperative outcome after hepatectomy with a new bedside test for maximal liver function capacity. Ann Surg 250(1):119–125PubMedCrossRef
6.
go back to reference Assy N, Minuk GY (1997) Liver regeneration: methods for monitoring and their applications. J Hepatol 26(4):945–952PubMedCrossRef Assy N, Minuk GY (1997) Liver regeneration: methods for monitoring and their applications. J Hepatol 26(4):945–952PubMedCrossRef
7.
go back to reference Kwon AH, Matsui Y, Kaibori M, Kamiyama Y (2004) Functional hepatic regeneration following hepatectomy using galactosyl-human serum albumin liver scintigraphy. Transplant Proc 36(8):2257–2260PubMedCrossRef Kwon AH, Matsui Y, Kaibori M, Kamiyama Y (2004) Functional hepatic regeneration following hepatectomy using galactosyl-human serum albumin liver scintigraphy. Transplant Proc 36(8):2257–2260PubMedCrossRef
8.
go back to reference Nagino M, Ando M, Kamiya J, Uesaka K, Sano T, Nimura Y (2001) Liver regeneration after major hepatectomy for biliary cancer. Br J Surg 88(8):1084–1091PubMedCrossRef Nagino M, Ando M, Kamiya J, Uesaka K, Sano T, Nimura Y (2001) Liver regeneration after major hepatectomy for biliary cancer. Br J Surg 88(8):1084–1091PubMedCrossRef
9.
go back to reference Stockmann M, Lock JF, Malinowski M, Niehues SM, Seehofer D, Neuhaus P (2010) The LiMAx test—a new liver function test for prediction of postoperative outcome in liver surgery. HPB (Oxford) 12(2):139–146CrossRef Stockmann M, Lock JF, Malinowski M, Niehues SM, Seehofer D, Neuhaus P (2010) The LiMAx test—a new liver function test for prediction of postoperative outcome in liver surgery. HPB (Oxford) 12(2):139–146CrossRef
10.
go back to reference Lock JF, Schwabauer E, Martus P, Videv N, Pratschke J, Malinowski M, Neuhaus P, Stockmann M (2010) Early diagnosis of primary nonfunction and indication for reoperation after liver transplantation. Liver Transpl 16(2):172–180PubMedCrossRef Lock JF, Schwabauer E, Martus P, Videv N, Pratschke J, Malinowski M, Neuhaus P, Stockmann M (2010) Early diagnosis of primary nonfunction and indication for reoperation after liver transplantation. Liver Transpl 16(2):172–180PubMedCrossRef
11.
go back to reference Stockmann M, Lock JF, Malinowski M, Seehofer D, Puhl G, Pratschke J, Neuhaus P (2010) How to define initial poor graft function after liver transplantation?—a new functional definition by the LiMAx test. Transpl Int 23:1023–1032 Stockmann M, Lock JF, Malinowski M, Seehofer D, Puhl G, Pratschke J, Neuhaus P (2010) How to define initial poor graft function after liver transplantation?—a new functional definition by the LiMAx test. Transpl Int 23:1023–1032
12.
go back to reference Lock JF, Malinowski M, Schwabauer E, Martus P, Pratschke J, Seehofer D, Puhl G, Neuhaus P, Stockmann M (2011) Initial liver graft function is a reliable predictor of tacrolimus trough levels during the first post-transplant week. Clin Transplant 25(3):436–443PubMedCrossRef Lock JF, Malinowski M, Schwabauer E, Martus P, Pratschke J, Seehofer D, Puhl G, Neuhaus P, Stockmann M (2011) Initial liver graft function is a reliable predictor of tacrolimus trough levels during the first post-transplant week. Clin Transplant 25(3):436–443PubMedCrossRef
13.
go back to reference Niehues SM, Unger JK, Malinowski M, Neymeyer J, Hamm B, Stockmann M (2010) Liver volume measurement: reason of the difference between in vivo CT-volumetry and intraoperative ex vivo determination and how to cope it. Eur J Med Res 15(8):345–350PubMedCrossRef Niehues SM, Unger JK, Malinowski M, Neymeyer J, Hamm B, Stockmann M (2010) Liver volume measurement: reason of the difference between in vivo CT-volumetry and intraoperative ex vivo determination and how to cope it. Eur J Med Res 15(8):345–350PubMedCrossRef
14.
go back to reference Chen MF, Hwang TL, Hung CF (1991) Human liver regeneration after major hepatectomy. A study of liver volume by computed tomography. Ann Surg 213(3):227–229PubMedCrossRef Chen MF, Hwang TL, Hung CF (1991) Human liver regeneration after major hepatectomy. A study of liver volume by computed tomography. Ann Surg 213(3):227–229PubMedCrossRef
15.
16.
go back to reference Lindner P, Cahlin C, Friman S, Hafstrom L, Klingenstierna H, Lonn L, Olausson M, Rizell M (2006) Extended right-sided liver resection for colorectal liver metastases—impact of percutaneous portal venous embolisation. Eur J Surg Oncol 32(3):292–296PubMedCrossRef Lindner P, Cahlin C, Friman S, Hafstrom L, Klingenstierna H, Lonn L, Olausson M, Rizell M (2006) Extended right-sided liver resection for colorectal liver metastases—impact of percutaneous portal venous embolisation. Eur J Surg Oncol 32(3):292–296PubMedCrossRef
17.
go back to reference Yamanaka N, Okamoto E, Kawamura E, Kato T, Oriyama T, Fujimoto J, Furukawa K, Tanaka T, Tomoda F, Tanaka W (1993) Dynamics of normal and injured human liver regeneration after hepatectomy as assessed on the basis of computed tomography and liver function. Hepatology 18(1):79–85PubMedCrossRef Yamanaka N, Okamoto E, Kawamura E, Kato T, Oriyama T, Fujimoto J, Furukawa K, Tanaka T, Tomoda F, Tanaka W (1993) Dynamics of normal and injured human liver regeneration after hepatectomy as assessed on the basis of computed tomography and liver function. Hepatology 18(1):79–85PubMedCrossRef
18.
go back to reference Selzner M, Clavien PA (2000) Failure of regeneration of the steatotic rat liver: disruption at two different levels in the regeneration pathway. Hepatology 31(1):35–42PubMedCrossRef Selzner M, Clavien PA (2000) Failure of regeneration of the steatotic rat liver: disruption at two different levels in the regeneration pathway. Hepatology 31(1):35–42PubMedCrossRef
19.
go back to reference Yang SQ, Lin HZ, Mandal AK, Huang J, Diehl AM (2001) Disrupted signaling and inhibited regeneration in obese mice with fatty livers: implications for nonalcoholic fatty liver disease pathophysiology. Hepatology 34(4 Pt 1):694–706PubMedCrossRef Yang SQ, Lin HZ, Mandal AK, Huang J, Diehl AM (2001) Disrupted signaling and inhibited regeneration in obese mice with fatty livers: implications for nonalcoholic fatty liver disease pathophysiology. Hepatology 34(4 Pt 1):694–706PubMedCrossRef
20.
go back to reference Balzan S, Nagarajan G, Farges O, Galleano CZ, Dokmak S, Paugam C, Belghiti J (2010) Safety of liver resections in obese and overweight patients. World J Surg 34(12):2960–2968PubMedCrossRef Balzan S, Nagarajan G, Farges O, Galleano CZ, Dokmak S, Paugam C, Belghiti J (2010) Safety of liver resections in obese and overweight patients. World J Surg 34(12):2960–2968PubMedCrossRef
21.
go back to reference Vigano L, Kluger MD, Laurent A, Tayar C, Merle JC, Lauzet JY, Andreoletti M, Cherqui D (2011) Liver resection in obese patients: results of a case-control study. HPB (Oxford) 13(2):103–111CrossRef Vigano L, Kluger MD, Laurent A, Tayar C, Merle JC, Lauzet JY, Andreoletti M, Cherqui D (2011) Liver resection in obese patients: results of a case-control study. HPB (Oxford) 13(2):103–111CrossRef
22.
go back to reference Cucchetti A, Cescon M, Ercolani G, Di Gioia P, Peri E, Pinna AD (2011) Safety of hepatic resection in overweight and obese patients with cirrhosis. Br J Surg 98(8):1147–1154PubMedCrossRef Cucchetti A, Cescon M, Ercolani G, Di Gioia P, Peri E, Pinna AD (2011) Safety of hepatic resection in overweight and obese patients with cirrhosis. Br J Surg 98(8):1147–1154PubMedCrossRef
23.
go back to reference Lui JP, Gluud LL, Als-Nielsen B, Gluud C (2004) Artificial and bioartificial support systems for liver failure. Cochrane Database Systematic Reviews (1):CD003628 Lui JP, Gluud LL, Als-Nielsen B, Gluud C (2004) Artificial and bioartificial support systems for liver failure. Cochrane Database Systematic Reviews (1):CD003628
24.
go back to reference Kaffarnik MF, Lock JF, Seehofer D, Stockmann M, Neuhaus P (2011) Liver resections—perioperative care. Viszeralmedizin 27(1):65–73CrossRef Kaffarnik MF, Lock JF, Seehofer D, Stockmann M, Neuhaus P (2011) Liver resections—perioperative care. Viszeralmedizin 27(1):65–73CrossRef
25.
go back to reference Nagasue N, Yukaya H, Ogawa Y, Kohno H, Nakamura T (1987) Human liver regeneration after major hepatic resection. A study of normal liver and livers with chronic hepatitis and cirrhosis. Ann Surg 206(1):30–39PubMedCrossRef Nagasue N, Yukaya H, Ogawa Y, Kohno H, Nakamura T (1987) Human liver regeneration after major hepatic resection. A study of normal liver and livers with chronic hepatitis and cirrhosis. Ann Surg 206(1):30–39PubMedCrossRef
26.
go back to reference Kamel IR, Erbay N, Warmbrand G, Kruskal JB, Pomfret EA, Raptopoulos V (2003) Liver regeneration after living adult right lobe transplantation. Abdom Imaging 28(1):53–57PubMedCrossRef Kamel IR, Erbay N, Warmbrand G, Kruskal JB, Pomfret EA, Raptopoulos V (2003) Liver regeneration after living adult right lobe transplantation. Abdom Imaging 28(1):53–57PubMedCrossRef
27.
go back to reference Miyagawa S, Kawasaki S, Noike T, Nomura K, Kobayashi A, Shimada R, Imamura H (1999) Liver regeneration after extended right hemihepatectomy in patients with hilar or diffuse bile duct carcinoma. Hepatogastroenterology 46(25):364–368PubMed Miyagawa S, Kawasaki S, Noike T, Nomura K, Kobayashi A, Shimada R, Imamura H (1999) Liver regeneration after extended right hemihepatectomy in patients with hilar or diffuse bile duct carcinoma. Hepatogastroenterology 46(25):364–368PubMed
28.
go back to reference Nadalin S, Testa G, Malago M, Beste M, Frilling A, Schroeder T, Jochum C, Gerken G, Broelsch CE (2004) Volumetric and functional recovery of the liver after right hepatectomy for living donation. Liver Transpl 10(8):1024–1029PubMedCrossRef Nadalin S, Testa G, Malago M, Beste M, Frilling A, Schroeder T, Jochum C, Gerken G, Broelsch CE (2004) Volumetric and functional recovery of the liver after right hepatectomy for living donation. Liver Transpl 10(8):1024–1029PubMedCrossRef
29.
go back to reference Kobayashi T, Imamura H, Aoki T, Sugawara Y, Kokudo N, Makuuchi M (2006) Morphological regeneration and hepatic functional mass after right hemihepatectomy. Dig Surg 23(1–2):44–50PubMedCrossRef Kobayashi T, Imamura H, Aoki T, Sugawara Y, Kokudo N, Makuuchi M (2006) Morphological regeneration and hepatic functional mass after right hemihepatectomy. Dig Surg 23(1–2):44–50PubMedCrossRef
30.
go back to reference Cho JY, Suh KS, Kwon CH, Yi NJ, Lee HH, Park JW, Lee KW, Joh JW, Lee SK, Lee KU (2006) Outcome of donors with a remnant liver volume of less than 35 % after right hepatectomy. Liver Transpl 12(2):201–206PubMedCrossRef Cho JY, Suh KS, Kwon CH, Yi NJ, Lee HH, Park JW, Lee KW, Joh JW, Lee SK, Lee KU (2006) Outcome of donors with a remnant liver volume of less than 35 % after right hepatectomy. Liver Transpl 12(2):201–206PubMedCrossRef
31.
go back to reference Pomfret EA, Pomposelli JJ, Gordon FD, Erbay N, Lyn Price L, Lewis WD, Jenkins RL (2003) Liver regeneration and surgical outcome in donors of right-lobe liver grafts. Transplantation 76(1):5–10PubMedCrossRef Pomfret EA, Pomposelli JJ, Gordon FD, Erbay N, Lyn Price L, Lewis WD, Jenkins RL (2003) Liver regeneration and surgical outcome in donors of right-lobe liver grafts. Transplantation 76(1):5–10PubMedCrossRef
32.
go back to reference Radtke A, Sotiropoulos GC, Nadalin S, Molmenti EP, Schroeder T, Lang H, Saner F, Valentin-Gamazo C, Frilling A, Schenk A et al (2007) Preoperative volume prediction in adult living donor liver transplantation: how much can we rely on it? Am J Transplant 7(3):672–679PubMedCrossRef Radtke A, Sotiropoulos GC, Nadalin S, Molmenti EP, Schroeder T, Lang H, Saner F, Valentin-Gamazo C, Frilling A, Schenk A et al (2007) Preoperative volume prediction in adult living donor liver transplantation: how much can we rely on it? Am J Transplant 7(3):672–679PubMedCrossRef
33.
go back to reference Cucchetti A, Ercolani G, Cescon M, Ravaioli M, Zanello M, Del Gaudio M, Lauro A, Vivarelli M, Grazi GL, Pinna AD (2006) Recovery from liver failure after hepatectomy for hepatocellular carcinoma in cirrhosis: meaning of the model for end-stage liver disease. J Am Coll Surg 203(5):670–676PubMedCrossRef Cucchetti A, Ercolani G, Cescon M, Ravaioli M, Zanello M, Del Gaudio M, Lauro A, Vivarelli M, Grazi GL, Pinna AD (2006) Recovery from liver failure after hepatectomy for hepatocellular carcinoma in cirrhosis: meaning of the model for end-stage liver disease. J Am Coll Surg 203(5):670–676PubMedCrossRef
34.
go back to reference Jochum C, Beste M, Penndorf V, Farahani MS, Testa G, Nadalin S, Malago M, Broelsch CE, Gerken G (2006) Quantitative liver function tests in donors and recipients of living donor liver transplantation. Liver Transpl 12(4):544–549PubMedCrossRef Jochum C, Beste M, Penndorf V, Farahani MS, Testa G, Nadalin S, Malago M, Broelsch CE, Gerken G (2006) Quantitative liver function tests in donors and recipients of living donor liver transplantation. Liver Transpl 12(4):544–549PubMedCrossRef
35.
go back to reference Ishii Y, Asai S, Kohno T, Ito A, Iwai S, Ishikawa K (2002) Recovery of liver function in two-third partial hepatectomized rats evaluated by L-[1-13C]phenylalanine breath test. Surgery 132(5):849–856PubMedCrossRef Ishii Y, Asai S, Kohno T, Ito A, Iwai S, Ishikawa K (2002) Recovery of liver function in two-third partial hepatectomized rats evaluated by L-[1-13C]phenylalanine breath test. Surgery 132(5):849–856PubMedCrossRef
Metadata
Title
Function and volume recovery after partial hepatectomy: influence of preoperative liver function, residual liver volume, and obesity
Authors
Johan Friso Lock
Maciej Malinowski
Daniel Seehofer
Steffi Hoppe
Rhea Isabel Röhl
Stefan Markus Niehues
Peter Neuhaus
Martin Stockmann
Publication date
01-12-2012
Publisher
Springer-Verlag
Published in
Langenbeck's Archives of Surgery / Issue 8/2012
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI
https://doi.org/10.1007/s00423-012-0972-2

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