Function and volume recovery after partial hepatectomy: influence of preoperative liver function, residual liver volume, and obesity.
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.


CONCLUSIONS
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.
Department of General, Visceral and Transplantation Surgery, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany. johan.lock@charite.de
Johan Friso
JF
Lock
Maciej
M
Malinowski
Daniel
D
Seehofer
Steffi
S
Hoppe
Rhea Isabel
RI
Röhl
Stefan Markus
SM
Niehues
Peter
P
Neuhaus
Martin
M
Stockmann
D005260:Female; D006498:Hepatectomy; D006801:Humans; D008099:Liver / Q000473:pathology*; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000503:physiopathology / Q000601:surgery; D008115:Liver Regeneration; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000503:physiopathology*; D009929:Organ Size