Preoperative galactose elimination capacity predicts complications and survival after hepatic resection

Abstract

Objective: To analyze a single center's 6-year experience with 258 consecutive patients undergoing major hepatic resection for primary or secondary malignancy of the liver, and to examine the predictive value of preoperative liver function assessment.

Summary background data: Despite the substantial improvements in diagnostic and surgical techniques that have made liver surgery a safer procedure, careful patient selection remains mandatory to achieve good results in patients with hepatic tumors.

Methods: In this prospective study, 258 patients undergoing hepatic resection were enrolled: 111 for metastases, 78 for hepatocellular carcinoma (HCC), 21 for cholangiocellular carcinoma, and 48 for other primary hepatic tumors. One hundred fifty-eight patients underwent segment-oriented liver resection, including hemihepatectomies, and 100 had subsegmental resections. Thirty-two clinical and biochemical parameters were analyzed, including liver function assessment by the galactose elimination capacity (GEC) test, a measure of hepatic functional reserve, to predict postoperative (60-day) rates of death and complications and long-term survival. All variables were determined within 5 days before surgery. Data were subjected to univariate and multivariate analysis for two patient subgroups (HCC and non-HCC). The cutoffs for GEC in both groups were predefined. Long-term survival (>60 days) was subjected to Kaplan-Meier analysis and the Cox proportional hazard model.

Results: In the entire group of 258 patients, a GEC less than 6 mg/min/kg was the only preoperative biochemical parameter that predicted postoperative complications and death by univariate and stepwise regression analysis. A GEC of more than 6 mg/min/kg was also significantly associated with longer survival. This predictive value could also be shown in the subgroup of 180 patients with tumors other than HCC. In the subgroup of 78 patients with HCC, a GEC less than 4 mg/min/kg predicted postoperative complications and death by univariate and stepwise regression analysis. Further, a GEC of more than 4 mg/min/kg was also associated with longer survival.

Conclusions: This prospective study establishes the preoperative determination of the hepatic reserve by GEC as a strong independent and valuable predictor for short- and long-term outcome in patients with primary and secondary hepatic tumors undergoing resection.

Figure 1. Comparison of survival rates (Kaplan-Meier) between different diagnoses in patients undergoing hepatic resection for malignancies. Median survival for cholangiocarcinoma (CCC) was significantly worse (18 months) than that for colorectal carcinoma (CRC, 48 months) and that for hepatocellular carcinoma (HCC, 41 months). Log-rank test, P = .0173.

Figure 2. Cumulative survival for patients with hepatocellular carcinoma in terms of preoperative liver function (galactose elimination capacity [GEC], mg/min/kg). Log-rank test, P = .003.

Figure 3. Cumulative survival for patients without hepatocellular carcinoma in terms of preoperative pathologic galactose elimination capacity (GEC) test. Log-rank test, P = .0282.