title: Advances in preoperative assessment of liver function.
abstract: BACKGROUND
  Postoperative liver failure remains a life-threatening complication. Preoperative evaluation of liver function is essential in reducing the complications after hepatectomy. However, it is difficult to accurately evaluate liver function before surgery because of the limitations of the liver function tests available. Recent advances in liver function tests improved the ability to assess liver function. The present review was to analyze these methods and their advantages.
  
  
  METHODS
  MEDLINE was searched using the terms of "liver function test", "liver function evaluation" and "galactosyl serum albumin". Relevant articles published in English and Chinese from 1961 to 2014 were reviewed.
  
  
  RESULTS
  Although serological tests are used frequently in practice, they reflect the degree of total liver damage or function, not the remnant of liver function. Child-Pugh score and model for end-stage liver disease (MELD) score assess whole liver function, and are particularly useful in determining whether patients with hepatocellular carcinoma and cirrhosis are candidates for resection or transplantation, but cannot determine the safe extent or removal. The indocyanine green and other metabolic quantitative liver function tests can evaluate functional hepatocytes, making them more accurate in predicting liver function. Computed tomography (CT) volumetry can provide anatomic information on the remnant liver volume but not on functional volume. 99mTc-galactosyl serum albumin scintigraphy, combined with single photon emission computed tomography, CT and three-dimensional reconstruction, may be a better quantitative measure of liver function, especially of remnant liver function.
  
  
  CONCLUSIONS
  Tests used to evaluate liver functional reserve and to predict surgical risk have limitations. 99mTc-galactosyl serum albumin scintigraphy, which can more accurately evaluate the whole and regional liver function, may be promising in predicting resection margins and risks of liver failure.
authors.affiliation: Department of Liver Surgery, Peking Union Medical College (PUMC) Hospital, Chinese Academy of Medical Sciences and PUMC, Beijing 100730, China. yileimao@126.com.
authors.forename: Peng-Lei
authors.initials: PL
authors.lastname: Ge
authors.forename: Shun-Da
authors.initials: SD
authors.lastname: Du
authors.forename: Yi-Lei
authors.initials: YL
authors.lastname: Mao
mesh_terms: D015415:Biomarkers / Q000378:metabolism; D006498:Hepatectomy / Q000009:adverse effects; D006801:Humans; D008107:Liver Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000378:metabolism / Q000601:surgery*; D017093:Liver Failure / Q000209:etiology / Q000517:prevention & control*; D008111:Liver Function Tests; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods*; D019275:Radiopharmaceuticals; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013668:Technetium Tc 99m Aggregated Albumin; D016284:Technetium Tc 99m Pentetate; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D019275:Radiopharmaceuticals; D013668:Technetium Tc 99m Aggregated Albumin; C070561:technetium Tc 99m DTPA-galactosyl-human serum albumin; D016284:Technetium Tc 99m Pentetate