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. 2022 May 27;11(11):3018.
doi: 10.3390/jcm11113018.

The LiMAx Test as Selection Criteria in Minimally Invasive Liver Surgery

Mirhasan Rahimli  1 , Aristotelis Perrakis  1 , Andrew A Gumbs  2 , Mihailo Andric  1 , Sara Al-Madhi  1 , Joerg Arend  1 , Roland S Croner  1
Affiliations

The LiMAx Test as Selection Criteria in Minimally Invasive Liver Surgery

Mirhasan Rahimli et al. J Clin Med. .

Abstract

Background: Liver failure is a crucial predictor for relevant morbidity and mortality after hepatic surgery. Hence, a good patient selection is mandatory. We use the LiMAx test for patient selection for major or minor liver resections in robotic and laparoscopic liver surgery and share our experience here.

Patients and methods: We identified patients in the Magdeburg registry of minimally invasive liver surgery (MD-MILS) who underwent robotic or laparoscopic minor or major liver surgery and received a LiMAx test for preoperative evaluation of the liver function. This cohort was divided in two groups: patients with normal (LiMAx normal) and decreased (LiMAx decreased) liver function measured by the LiMAx test.

Results: Forty patients were selected from the MD-MILS regarding the selection criteria (LiMAx normal, n = 22 and LiMAx decreased, n = 18). Significantly more major liver resections were performed in the LiMAx normal vs. the LiMAx decreased group (13 vs. 2; p = 0.003). Hence, the mean operation time was significantly longer in the LiMAx normal vs. the LiMAx decreased group (356.6 vs. 228.1 min; p = 0.003) and the intraoperative blood transfusion significantly higher in the LiMAx normal vs. the LiMAx decreased group (8 vs. 1; p = 0.027). There was no significant difference between the LiMAx groups regarding the length of hospital stay, intraoperative blood loss, liver surgery related morbidity or mortality, and resection margin status.

Conclusion: The LiMAx test is a helpful and reliable tool to precisely determine the liver function capacity. It aids in accurate patient selection for major or minor liver resections in minimally invasive liver surgery, which consequently serves to improve patients' safety. In this way, liver resections can be performed safely, even in patients with reduced liver function, without negatively affecting morbidity, mortality and the resection margin status, which is an important predictive oncological factor.

Keywords: LiMAx; cirrhosis; colorectal liver metastasis; hepatectomy; hepatocellular carcinoma; laparoscopic surgery; liver function; liver surgery; robotic surgery.

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Conflict of interest statement

The authors declare no conflict of interest.

References

    1. Filmann N., Walter D., Schadde E., Bruns C., Keck T., Lang H., Oldhafer K., Schlitt H.J., Schön M.R., Herrmann E., et al. Mortality after liver surgery in Germany. Br. J. Surg. 2019;106:1523–1529. doi: 10.1002/bjs.11236. - DOI - PubMed
    1. Stockmann M., Lock J.F., Malinowski M., Niehues S.M., Seehofer D., Neuhaus P. The LiMAx test: A new liver function test for predicting postoperative outcome in liver surgery. HPB. 2010;12:139–146. doi: 10.1111/j.1477-2574.2009.00151.x. - DOI - PMC - PubMed
    1. Jara M., Bednarsch J., Valle E., Lock J.F., Malinowski M., Schulz A., Seehofer D., Jung T., Stockmann M. Reliable assessment of liver function using LiMAx. J. Surg. Res. 2015;193:184–189. doi: 10.1016/j.jss.2014.07.041. - DOI - PubMed
    1. Bednarsch J., Jara M., Lock J.F., Malinowski M., Pratschke J., Stockmann M. Noninvasive diagnosis of chemotherapy induced liver injury by LiMAx test--two case reports and a review of the literature. BMC Res. Notes. 2015;8:99. doi: 10.1186/s13104-015-1055-6. - DOI - PMC - PubMed
    1. Buechter M., Gerken G., Hoyer D.P., Bertram S., Theysohn J.M., Thodou V., Kahraman A. Liver maximum capacity (LiMAx) test as a helpful prognostic tool in acute liver failure with sepsis: A case report. BMC Anesthesiol. 2018;18:71. doi: 10.1186/s12871-018-0538-0. - DOI - PMC - PubMed

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