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Surgery Today
Published in: Surgery Today 9/2016

01-09-2016 | Original Article

Preliminary study on liver function changes after trisectionectomy with versus without prior portal vein embolization

Authors: Maciej Malinowski, Johan Friso Lock, Daniel Seehofer, Bernhard Gebauer, Antje Schulz, Lina Demirel, Jan Bednarsch, Victoria Stary, Peter Neuhaus, Martin Stockmann

Published in: Surgery Today | Issue 9/2016

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Abstract

Purpose

Post-hepatectomy liver failure (PHLF) is the major risk factor for mortality after hepatectomy. Preoperative planning of the future liver remnant volume reduces PHLF rates; however, future liver remnant function (FLR-F) might have an even stronger predictive value. In this preliminary study, we used a new method to calculate FLR-F by the LiMAx test and computer tomography-assisted volumetric-analysis to visualize liver function changes after portal vein embolization (PVE) before extended hepatectomy.

Methods

The subjects included patients undergoing extended right hepatectomy either directly (NO-PVE group) or after PVE (PVE group). Computed tomography (CT) scan and liver function tests (LiMAx) were done before PVE and preoperatively. FLR-F was calculated and correlated with the postoperative liver function.

Results

There were 12 patients in the NO-PVE group and 19 patients in the PVE group. FLR-F and postoperative liver function correlated significantly in both groups (p = 0.036, p = 0.011), although postoperative liver function was slightly overestimated, at 32 and 45 µg/kg/min, in the NO-PVE and PVE groups, respectively. LiMAx value did not change after PVE.

Conclusions

Volume–function analysis using LiMAx and CT scan enables us to reliably predict early postoperative liver function. Global enzymatic liver function measured by the LiMAx test did not change after PVE, confirming that liver function distribution in the liver stays constant after PVE. An overestimation of FLR-F is needed to compensate for the intraoperative liver injury that occurs in patients undergoing extended hepatectomy.
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Metadata
Title
Preliminary study on liver function changes after trisectionectomy with versus without prior portal vein embolization
Authors
Maciej Malinowski
Johan Friso Lock
Daniel Seehofer
Bernhard Gebauer
Antje Schulz
Lina Demirel
Jan Bednarsch
Victoria Stary
Peter Neuhaus
Martin Stockmann
Publication date
01-09-2016
Publisher
Springer Japan
Published in
Surgery Today / Issue 9/2016
Print ISSN: 0941-1291
Electronic ISSN: 1436-2813
DOI
https://doi.org/10.1007/s00595-015-1293-1

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