The LiMAx test: a new liver function test for predicting postoperative outcome in liver surgery. Sinusoidal obstruction syndrome compromises liver regeneration in patients undergoing two-stage hepatectomy with portal vein embolization Hepatic histology in obese patients undergoing bariatric surgery.
BACKGROUND Liver failure has remained a major cause of mortality after hepatectomy , but it is difficult to predict preoperatively . This study describes the introduction into clinical practice of the new LiMAx test and provides an algorithm for its use in the clinical management of hepatic tumours . METHODS Patients with hepatic tumours and indications for hepatectomy were investigated perioperatively with the LiMAx test . In one patient , analysis of liver volume was carried out with preoperative three-dimensional virtual resection . RESULTS A total of 329 patients with hepatic tumours were evaluated for hepatectomy . Blinded preoperative LiMAx values were significantly higher before resection ( n= 139 ; mean 351 microg/kg/h , range 285 - 451 microg/kg/h ) than before refusal ( n= 29 ; mean 299 microg/kg/h , range 223 - 376 microg/kg/h ; P= 0.009 ) . In-hospital mortality rates were 38.1 % ( 8/21 patients ) , 10.5 % ( 2/19 patients ) and 1.0 % ( 1/99 patients ) for postoperative LiMAx of < 80 microg/kg/h , 80 - 100 microg/kg/h and > 100 microg/kg/h , respectively ( P < 0.0001 ) . A decision tree was developed to avoid critical values and its prospect i ve preoperative application revealed a reduction in mortality from 9.4 % to 3.4 % ( P= 0.019 ) . DISCUSSION The LiMAx test can validly determine liver function capacity and is feasible in every clinical situation . Combination with virtual resection could enable the calculation of residual liver function . The LiMAx decision tree algorithm for hepatectomy might significantly improve preoperative evaluation and postoperative outcome in liver surgery Purpose Several factors have been reported to affect liver regeneration after portal vein embolization ( PVE ) ; however , the effect of sinusoidal obstruction syndrome ( SOS ) has not been evaluated . Therefore , we assessed the effect of SOS on liver regeneration after PVE in patients with multiple bilobar colorectal liver metastases scheduled to undergo two-stage hepatectomy ( TSH ) combined with PVE .  Methods The subjects of this study were 78 patients prospect ively scheduled to undergo TSH between December 1996 and August 2009 . Archived formalin-fixed , paraffin-embedded nontumoral tissue sample s were collected from the 1st- and 2nd-stage hepatectomies in 42 and 45 patients , respectively , and SOS and steatohepatitis were diagnosed pathologically . We analyzed the clinicopathological variables affecting liver regeneration after PVE . Results Sinusoidal obstruction syndrome was diagnosed in 11 ( 26.2 % ) and 20 patients ( 44.4 % ) at the time of the 1st- and 2nd-stage hepatectomy , respectively . Patients with SOS at the 1st-stage hepatectomy had a significantly lower hypertrophy ratio of the future remnant liver ( FRL ) after PVE than patients without SOS ( 16.8 ± 24.0 vs 55.6 ± 32.5 ; P < 0.001 ) . Multivariate logistic regression analysis revealed that SOS was an independent factor predicting lower FRL hypertrophy after PVE ( Δ% FRL < 20 : hazard ratio 31.7 , 95 % confidence interval 2.84–355.12 ; P = 0.005 ) . The incidence of postoperative transient liver failure after the 2nd-stage hepatectomy in patients presenting with SOS was higher than that in those without SOS , but the difference did not reach significance ( 25.0 % vs 4.0 % ; P = 0.052 ) . Steatohepatitis was confirmed at the 1st- and 2nd-stage hepatectomy in 6 ( 14.3 % ) and 3 ( 6.7 % ) patients , respectively . ConclusionS inusoidal obstruction syndrome inhibits FRL hypertrophy after PVE and induces postoperative liver failure . Therefore , an alternative strategy is needed to perform TSH safely in the presence of SOS BACKGROUND / AIMS Obesity is one of the most important clinical associations with non-alcoholic steatohepatitis ( NASH ) . Our aim was to assess the prevalence of non-alcoholic fatty liver disease (NAFLD)/NASH in morbidly obese patients and the risk factors to more aggressive liver disease in this population . METHODS Review of available studies on prevalence of NAFLD/NASH in severely obese patients su bmi tted to bariatric surgery .  RESULTS Twelve observational and transversal studies were included , with consecutive recruitment , and prospect i ve evaluation of data , summing 1620 patients with severe obesity .  Prevalence of steatosis and NASH was 91 % ( range : 85 - 98 % ) and 37 % ( 24 - 98 % ) , respectively , with unexpected cirrhosis in 1.7 % ( 1 - 7 % ) . NASH was not related with age or body mass index , but there was an association between male sex and NASH/hepatic fibrosis . Diabetes mellitus and insulin resistance were the conditions most frequently associated with NASH , and hypertension with advanced hepatic fibrosis . CONCLUSIONS There is a very high prevalence of NAFLD in asymptomatic morbidly obese patients , more than one-third presenting histological criteria for NASH . This review underscores the large variations in prevalence of NASH between studies , calling for the need for a better agreement in the use of the histological criteria
Background Chemotherapy-associated liver injury is a major cause for concern when treating patients with colorectal liver metastases .
The aim of this review was to determine the pathological effect of specific chemotherapy regimens on the hepatic parenchyma as well as on surgical morbidity , mortality and overall survival .