Liver Function Assessment Techniques in Surgical Oncology

Accurate appraisal of hepatic reserve is fundamental to the safe and effective management of patients undergoing oncological liver resection. Traditional static scores such as Child-Pugh and Model for End-Stage Liver Disease (MELD) provide a global estimate of liver disease severity but lack sensitivity to acute changes in function. Dynamic assessments, notably the indocyanine green plasma disappearance rate and the maximum liver function capacity (LiMAx) breath test, offer real-time evaluation of metabolic and excretory performance. Complementary imaging techniques, including computed tomography (CT) volumetry and magnetic resonance elastography, quantify future liver remnant volume and parenchymal quality. Hybrid approaches that integrate functional imaging or machine-learning models with biochemical assays are emerging to predict regeneration and minimise postoperative liver failure. Together, these methods inform patient selection, guide two-stage procedures such as ALPPS (Associating Liver Partition and Portal vein ligation for Staged hepatectomy) and optimise timing of portal vein embolization, thereby reducing morbidity and enhancing oncological outcomes on a global scale.

Research from Nature Portfolio

Recent clinical trials have investigated the impact of modulating the gut–liver axis on postoperative recovery. A randomised study of perioperative rifaximin found no significant effect on functional regeneration or volumetric recovery after major hepatectomy, as measured by dynamic LiMAx testing and CT volumetry. Despite theoretical benefits of reducing bacterial translocation and systemic inflammation, neither the trajectory of liver function increase from postoperative day 4 to day 7 nor the course of volumetric hypertrophy was altered by antibiotic prophylaxis. This outcome underlines the robustness of direct functional assessment tools and suggests that pharmacological modulation of the microbiome may not substitute for established regeneration-monitoring techniques.

Liver Function Assessment Techniques in Surgical Oncology publication trend

The graph below shows the total number of articles in liver function assessment techniques in surgical oncology across all publications each year (not limited to Nature Index journals).

Technical terms

Child-Pugh score: A clinical classification combining bilirubin, albumin, coagulation and clinical signs to grade the severity of chronic liver disease.

Indocyanine green plasma disappearance rate (ICG-PDR): A dynamic clearance test measuring the rate at which indocyanine green is removed from plasma, reflecting hepatic blood flow and excretory function.

LiMAx test: A non-invasive breath test quantifying maximum metabolic liver capacity via 13C-methacetin metabolism by cytochrome P450 1A2.

CT volumetry: Computed tomography-based measurement of total liver and future liver remnant volumes to assess suitability for resection.

Portal vein embolization (PVE): A preoperative procedure occluding portal branches to induce compensatory hypertrophy of the future liver remnant.

Artificial neural network (ANN): A computational model of interconnected nodes used to predict clinical outcomes based on imaging or biochemical input data.

References

1. Perioperative rifaximin is not associated with enhanced functional and volumetric recovery after major liver resection. Scientific Reports (2021).
2. LiMAx Prior to Radioembolization for Hepatocellular Carcinoma as an Additional Tool for Patient Selection in Patients with Liver Cirrhosis. Cancers (2022).
3. CT-Based Prediction of Liver Function and Post-PVE Hypertrophy Using an Artificial Neural Network. Journal of Clinical Medicine (2021).