Preoperative prediction and prevention of intraoperative acute liver failure after major liver resection for metastatic colorectal cancer

Objective: improve the results of treatment of patients with metastatic cancer of liver by reducing the risk of post-resection liver failure based on the assessment of liver functional reserve.

Materials and methods. The study included 2 independent samples of patients underwent surgery for liver metastases in the department of abdominal oncology at the P. A. Herzen Moscow Oncological Research Institute. Group 1 included 47 patients: in addition to the standard treatment algorithm they underwent 13C methacetin breath test and dynamic scintigraphy of liver in the preoperative stage. Patients from the group 2 (n = 30) underwent standard clinical and laboratory examination, without preoperative evaluation of liver functional reserves; the level of total bilirubin, albumin and prothrombin time showed no decrease in liver function. Post-resection liver failure was established based on 50/50 criterion when evaluated on the 5th postoperative day.

Results. The analysis of operational characteristics of functional tests showed absolute sensitivity of 13C methacetin breath test (SE ≥ 100 %) and negative predictive value (–VP ≥ 100 %) in case of integrated application of 2 diagnostic methods. An incidence of post-resection acute liver failure in the study group was significantly 2.2-fold lower than in the control group – 10.6 % and 23.3 %, respectively (p < 0.001).

Conclusion. Combination of preoperative dynamic scintigraphy of liver with 13C methacetin breath test allows to perform comprehensive assessment of liver functional reserves, and it can greatly improve preoperative assessment and postoperative results of anatomic resections in patients with liver metastases.

1. Lin T. Y., Lee C. S., Chen C. C. et al. Regeneration of human liver after hepatic lobectomy studied by repeated liver scanning and repeated needle biopsy. Ann Surg 1979;190(1):48–53.

2. Vauthey J. N., Ellis L. M., Ellis V. et al. Recurrence and outcomes following hepatic resection, radiofrequency ablation, and combined resection/ablation for colorectal liver metastases. Ann Surg 2004;239(6):818–25.

3. Pawlik T. M., Schulick R. D., Choti M. A. Expanding criteria for resectability of colorectal liver metastases. Oncologist 2008;13(1):51–64.

4. de Haas R. J., Wicherts D. A., Flores E. et al. R1 resection by necessity for colorectal liver metastases: is it still a contraindication to surgery? Ann Surg 2008;248(4):626–37.

5. Donohue J. H., Que F. G., Farnell M. B. et al. Hepatic resection for colorectal metastases: value for risk scoring systems? Ann Surg 2007;246(2):183–91.

6. Shoup M., Gonen M., D’Angelica M. et al. Volumetric analysis predicts hepatic dysfunction in patients undergoing major liver resection. J Gastrointest Surg 2003;7:325–30.

7. Сидоров Д. В., Рубцова Н. А., Леонтьев А. В. и др. Методы оценки функционального статуса печени при планировании анатомических резекций по поводу первичных и метастатических опухолей: современное состояние проблемы, собственный опыт и перспективы. Исследования и практика в медицине 2015;2(1):13–20. [Sidorov D. V., Rubtsova N. А., Leontiev А. V. et al. Меthods of evaluation of the functional status of the liver when planning anatomic resections in case of initial and metastatic tumors: modern status of the problem, own experience and prospects. Issledovaniya i praktika v meditsine = Studies and Practice in Medicine 2015;2(1):13–20. (In Russ.)].

8. van den Broek M. A., Olde Damink S. W., Dejong C. H. et al. Liver failure after partial hepatic resection: definition, pathophysiology, risk factors and treatment. Liver international: official journal of the International Association for the Study of the Liver. Liver International 2008;28(6):767–80.