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.
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References
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):38–43
Schneider PD (2004) Preoperative assessment of liver function. Surg Clin North Am 84(2):355–373
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):1047–1056
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):767–780
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):119–125
Assy N, Minuk GY (1997) Liver regeneration: methods for monitoring and their applications. J Hepatol 26(4):945–952
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):2257–2260
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):1084–1091
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):139–146
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):172–180
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
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):436–443
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):345–350
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):227–229
Fausto N, Campbell JS, Riehle KJ (2006) Liver regeneration. Hepatology 43(2 Suppl 1):S45–S53
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):292–296
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):79–85
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):35–42
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):694–706
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):2960–2968
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):103–111
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):1147–1154
Lui JP, Gluud LL, Als-Nielsen B, Gluud C (2004) Artificial and bioartificial support systems for liver failure. Cochrane Database Systematic Reviews (1):CD003628
Kaffarnik MF, Lock JF, Seehofer D, Stockmann M, Neuhaus P (2011) Liver resections—perioperative care. Viszeralmedizin 27(1):65–73
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):30–39
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):53–57
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):364–368
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):1024–1029
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):44–50
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):201–206
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):5–10
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):672–679
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):670–676
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):544–549
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):849–856
Conflict of interest
Martin Stockmann is the inventor of the LiMAx test and has capital interest in Humedics, the company marketing the test.
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Lock, J.F., Malinowski, M., Seehofer, D. et al. Function and volume recovery after partial hepatectomy: influence of preoperative liver function, residual liver volume, and obesity. Langenbecks Arch Surg 397, 1297–1304 (2012). https://doi.org/10.1007/s00423-012-0972-2
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DOI: https://doi.org/10.1007/s00423-012-0972-2