Preoperative liver function assessments to estimate the prognosis and safety of liver resections


Liver function assessment is important to ensure safe surgical procedures in patients with hepatocellular disease. Because the liver influences a wide variety of functions, including protein synthesis and metabolic, immune and storage functions, no single parameter is sufficient to adequately address all of these functions. We reviewed the relevant literature concerning the scoring systems, functional tests, plasma parameters and imaging modalities currently used to evaluate the liver function in an attempt to determine which parameters provide the most comprehensive and useful results. While the Child–Pugh scoring system is the gold standard for liver disease assessment, the liver damage grading system recommended by the Liver Cancer Study Group of Japan is also useful. Various models for end-stage liver disease scoring are used for organ allocation. While the indocyanine green clearance test is widely accepted throughout the world, other assessments have not been used routinely for clinical evaluations. The levels of plasma proteins, including albumin, prealbumin, retinol binding protein, apolipoprotein, coagulation factors and antithrombin III, represent the liver productivity. Liver fibrotic markers also correlate with liver function. Imaging modalities such as 99mTc-galactosyl serum albumin scintigraphy, 99mTc-mebrofenin hepatobiliary scintigraphy and transient elastography are also available, but future studies are needed to validate their clinical efficacy.

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We thank Sandy Tan for help in preparing this manuscript and for valuable discussions. A part of this study was supported by a Grant-in-Aid for Scientific Research from the Ministry of Education, Culture, Sports, Science and Technology, Japan (No. 23591993) and Yuasa Memorial Foundation.

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The authors declare that they have no conflict of interest to disclose.

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Correspondence to Toru Mizuguchi.

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Mizuguchi, T., Kawamoto, M., Meguro, M. et al. Preoperative liver function assessments to estimate the prognosis and safety of liver resections. Surg Today 44, 1–10 (2014).

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  • Liver function
  • Hepatocellular carcinoma
  • Liver resection