Postoperative Liver Function Assessment in Hepatobiliary Surgery

Postoperative liver function assessment is critical to the safety and success of hepatobiliary surgery. Surgical removal of liver tissue reduces overall hepatic mass and may precipitate post-hepatectomy liver failure (PHLF), a leading cause of perioperative morbidity and mortality. Accurate evaluation of functional reserve informs decisions on resection extent, perioperative care and patient selection. Traditional static measures such as serum bilirubin, transaminases and coagulation profiles are supplemented by dynamic tests and imaging-based parameters to improve risk stratification. Advances in biochemical scoring systems, indocyanine green clearance assays, oxidative stress profiling and quantitative imaging have diversified the tools available. Integration of these modalities into predictive models supports personalised planning, minimises complications and underpins enhanced recovery pathways. This field continues to evolve in response to growing demand for complex liver resections in oncology and transplantation, emphasising global applicability and standardisation of assessment protocols.

Research from Nature Portfolio

A large cohort study of nearly 700 patients undergoing minor and major liver resections established indocyanine green (ICG) clearance as a reliable predictor of postoperative liver dysfunction. By analysing plasma disappearance rate (PDR) and retention rate at 15 minutes (R15), investigators identified optimal cut-offs—PDR < 19.5% min⁻¹ and R15 > 5.6%—that stratify risk across resection types. Multivariable analysis confirmed preoperative ICG clearance as an independent predictor of early dysfunction according to recognised clinical criteria. This work reinforces ICG clearance testing as a practical, reproducible tool to guide surgical planning and perioperative management.

Postoperative Liver Function Assessment in Hepatobiliary Surgery publication trend

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

Technical terms

Post-hepatectomy liver failure (PHLF): Impaired synthetic, excretory or detoxifying liver function following surgical resection, graded by clinical and laboratory thresholds.

Indocyanine green (ICG) clearance: A dynamic liver function test measuring plasma disappearance rate and retention at 15 minutes to assess hepatic perfusion and reserve.

APRI: Aspartate aminotransferase to platelet ratio index, a biochemical marker reflecting hepatic fibrosis and residual function.

ALBI grade: A prognostic score combining serum albumin and bilirubin to stratify liver dysfunction severity.

Extracellular volume (ECV): The fraction of liver tissue occupied by extracellular matrix, derived from contrast-enhanced CT to infer fibrosis and functional reserve.

Future liver remnant (FLR) ratio: The proportion of total liver volume expected to remain post-resection, critical for predicting postoperative function.

References

1. The value of indocyanine green clearance assessment to predict postoperative liver dysfunction in patients undergoing liver resection. Scientific Reports (2019).
2. The Interplay between Perioperative Oxidative Stress and Hepatic Dysfunction after Human Liver Resection: A Prospective Observational Pilot Study. Antioxidants (2024).
3. An APRI+ALBI-Based Multivariable Model as a Preoperative Predictor for Posthepatectomy Liver Failure. Annals of Surgery (2023).
4. CT-derived extracellular volume and liver volumetry can predict posthepatectomy liver failure in hepatocellular carcinoma. Insights into Imaging (2023).