Prognostic value of the monoethylglycinexylidide (MEGX)-test prior to liver resection.
OBJECTIVE
The critical issue before major hepatic resection is to evaluate and detect patients with a potentially increased risk of hepatic failure. In this study the prognostic value of the monoethylglycinexylidide (MEGX)- liver function test was evaluated with regards to clinical course and survival after partial liver resection.


METHODS
Between 1995 and 2000 a total of 55 patients (29 male, 26 female) underwent a partial liver resection at the Georg-August University of Göttingen. Forty-two patients were treated for malignant, and 13 for benign, disease. MEGX-testing was performed 15 and 30 minutes after a single-dose of 1mg/kg BW Lidocaine i.v. was applied.


RESULTS
MEGX-test results after 30 minutes had significant influence on hospital mortality. Patients who died during the hospital stay showed median MEGX-30 minutes results of 32 microg/L in (4-107 microg/L) in comparison to the surviving patients with a median 68 microg/L (16-176 microg/L) (p = 0.026). Furthermore, patients with MEGX scaled categories of 3 and 4 had a significantly lower surivial at 150 days (p = 0.008) and overall (p = 0.0002). There was an indirect impact of MEGX on hospital stay, costs and mortality reflecting high fluid loss: patients with lower loss of fluid over drainages had a significantly lower mortality at 150 days (p = 0.00046) and overall (p = 0.00008), than did patients with higher fluid loss. Low MEGX-values significantly influenced long hospital stay (p = 0.00001) and high costs (p = 0.00001). Pathologic MEGX in combination with increased age, increased BMI and extensive surgical procedures including resection of over 50% volume of the liver had a significant influence on complications (p = 0.015).


CONCLUSIONS
The preoperative MEGX-test, especially the 30 minutes value, is a useful medium to estimate the liver reserve in non-cirrhotic patients prior to liver resection. In combination with the resection volume it may be very useful to identify patients with a high risk of developing a postoperative liver failure.
Lorf
T
T
Department of General Surgery, Georg-August University of Göttingen Medical Center, Gottingen, Germany.
Schnitzbauer
A A
AA
Schaefers
S K H
SK
Scherer
M N
MN
Schlitt
H J
HJ
Oellerich
M
M
Becker
H
H
Obed
A
A
D000328:Adult; D000368:Aged; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008012:Lidocaine / Q000031:analogs & derivatives* / Q000378:metabolism; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011379:Prognosis; D018570:Risk Assessment
D008012:Lidocaine; C001173:monoethylglycinexylidide