title: Preoperative galactose elimination capacity predicts complications and survival after hepatic resection.
abstract: OBJECTIVE
  To analyze a single center's 6-year experience with 258 consecutive patients undergoing major hepatic resection for primary or secondary malignancy of the liver, and to examine the predictive value of preoperative liver function assessment.
  
  
  BACKGROUND
  Despite the substantial improvements in diagnostic and surgical techniques that have made liver surgery a safer procedure, careful patient selection remains mandatory to achieve good results in patients with hepatic tumors.
  
  
  METHODS
  In this prospective study, 258 patients undergoing hepatic resection were enrolled: 111 for metastases, 78 for hepatocellular carcinoma (HCC), 21 for cholangiocellular carcinoma, and 48 for other primary hepatic tumors. One hundred fifty-eight patients underwent segment-oriented liver resection, including hemihepatectomies, and 100 had subsegmental resections. Thirty-two clinical and biochemical parameters were analyzed, including liver function assessment by the galactose elimination capacity (GEC) test, a measure of hepatic functional reserve, to predict postoperative (60-day) rates of death and complications and long-term survival. All variables were determined within 5 days before surgery. Data were subjected to univariate and multivariate analysis for two patient subgroups (HCC and non-HCC). The cutoffs for GEC in both groups were predefined. Long-term survival (>60 days) was subjected to Kaplan-Meier analysis and the Cox proportional hazard model.
  
  
  RESULTS
  In the entire group of 258 patients, a GEC less than 6 mg/min/kg was the only preoperative biochemical parameter that predicted postoperative complications and death by univariate and stepwise regression analysis. A GEC of more than 6 mg/min/kg was also significantly associated with longer survival. This predictive value could also be shown in the subgroup of 180 patients with tumors other than HCC. In the subgroup of 78 patients with HCC, a GEC less than 4 mg/min/kg predicted postoperative complications and death by univariate and stepwise regression analysis. Further, a GEC of more than 4 mg/min/kg was also associated with longer survival.
  
  
  CONCLUSIONS
  This prospective study establishes the preoperative determination of the hepatic reserve by GEC as a strong independent and valuable predictor for short- and long-term outcome in patients with primary and secondary hepatic tumors undergoing resection.
authors.affiliation: Department of Visceral and Transplantation Surgery, University of Bern, Bern, Switzerland.
authors.forename: Claudio A
authors.initials: CA
authors.lastname: Redaelli
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Dufour
authors.forename: Markus
authors.initials: M
authors.lastname: Wagner
authors.forename: Martin
authors.initials: M
authors.lastname: Schilling
authors.forename: Jürg
authors.initials: J
authors.lastname: Hüsler
authors.forename: Lukas
authors.initials: L
authors.lastname: Krähenbühl
authors.forename: Markus W
authors.initials: MW
authors.lastname: Büchler
authors.forename: Jürg
authors.initials: J
authors.lastname: Reichen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic / Q000601:surgery; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000601:surgery*; D018281:Cholangiocarcinoma / Q000401:mortality / Q000601:surgery*; D003627:Data Interpretation, Statistical; D005260:Female; D005500:Follow-Up Studies; D005690:Galactose / Q000097:blood; D006498:Hepatectomy / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D008099:Liver / Q000502:physiology / Q000601:surgery*; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications; D011446:Prospective Studies; D012044:Regression Analysis; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors
chemical_list: D005690:Galactose