Preoperative evaluation of liver function in patients with hepatocellular carcinoma using the LiMAx test

Besides liver transplantation, resection surgery provides the best long term survival in patients with hepatocellular carcinoma. To properly select patients for surgery an adequate estimation of liver function is of great clinical importance.

We performed a retrospective analysis of patients diagnosed with HCC that had received the LiMAx test for evaluation of surgical treatment in our department. LiMAx is a non-invasive ¹³C-breath-test for specific measurement of cytochrom P450 capacity by intravenous administration of 2 mg/kg ¹³C-Methacetin. This system can be purchased commercially.

A total of 47 patients were identified. After evaluation of liver function 24 patients received resection surgery. The LiMAx results were higher in resected patients (392 vs. 247 µg/kg/h; P = 0,022). Patients diagnosed with liver cirrhosis had significantly lower results (242 vs. 450 µg/kg/h; P < 0,006). In 10 patients surgical treatment was cancelled due to reduced liver function (mean LiMAx 181 µg/kg/h). After surgery 7 patients presented with postoperative liver failure (5 patients grade A, 1 grade B and 1 grade C). Histologic assessment revealed complete liver cirrhosis in 5 resected patients not influencing their risk for postoperative liver failure.

Evaluation of preoperative liver function by the LiMAx test allows patient selection to reduce severe postoperative liver decompensation. In appropriate patients mortality and morbidity remains low, even in the presence of liver cirrhosis.