Influence of Pre-Operative Liver Functional Assessment Pathway on the Post-Operative Outcomes Following Hepatectomy

Introduction: Pre-operative assessment of liver function using liver function tests, 99m Tc-Mebrofinate SPECT-CT scan, and HVPG measurements could identify patients at higher risk of post hepatectomy liver failure (PHLF), allowing them to be selected for an appropriate management pathway. This study aimed to evaluate the effects of the novel pre-operative liver function assessment pathway on post-operative outcomes following liver resection. Methods: Liver functional assessment was included in the pre-operative pathway in January 2018. All the patients undergoing liver resection between January 2016 and November 2020 were included. Comparisons were made between the cohorts before (Group I) and after (Group II) implementation of the pathway. Post-operative biochemical parameters (POD 1,3,5,10), post-operative complication rates and 90-day mortality rate were compared between the groups. Results: A total of 1216 patients were included (Group I: 507 patients and Group II: 709 patients). Post-operative platelet counts on Day 1 (p=0.021), INR on Day 1, 3, 5 (p<0.001), albumin on Day1, 3, 5 (<0.001), sodium levels on Day 1, 3, 5 (p<0.001) were significantly better in Group II. White cell count and neutrophil counts decreased (p=0.001) with no significant reduction in the post-operative infective complication rates. PHLF rates decreased from 4.1% to 2.1% [Grade A], 0.6% to 0.4% [Grade B], and 1.0% to 0.7% [Grade C] respectively (p=0.175). Overall, 90-day mortality rate has decreased from 3 to 2.4% (p=0.588). Discussion: Pre-operative planning based on the assessment of liver parenchymal function using 99m Tc-Mebrofinate SPECT-CT scan and portal hypertension by wedge pressures, appears to improve post-hepatectomy outcomes.