Analysis of Postoperative Liver Function Tests in relation to Residual Liver Volume Fraction in Right Lobe Donors

Background In patients with bilobar metastatic liver disease, surgical clearance of both liver lobes may be achieved through multiple-stage liver resections. For patients with extensive disease, a major two-staged hepatectomy consisting of resection of liver segments II and III before right-sided portal vein embolization (PVE) and resection of segments V–VIII may be performed, leaving only segments IV ± I as the liver remnant. Purpose To describe the outcome following right-sided PVE after prior complete resection of liver segments II and III. Material and Methods In this retrospective study, 15 patients (mean age = 60.4 ± 9.3 years) with liver metastases from colorectal cancer (n = 14) and uveal melanoma (n = 1) who were scheduled to undergo a major two-stage hepatectomy, were included. Total liver volume (TLV) and volume of the future liver remnant (FLR) were measured on pre- and postinterventional computed tomography (CT) scans, and standardized FLR volumes (ratio FLR/TLV) were calculated. Patient data were retrospectively analyzed regarding peri- and postinterventional complications, with special emphasis on liver function tests. Results The mean standardized post-PVE FLR volume was 26.9% ± 6.4% and no patient developed hepatic insufficiency after the PVE. Based on FLR hypertrophy and liver function tests, all but one patient were considered eligible for the subsequent right-sided hepatectomy. However, due to local tumor progression, only 9/15 patients eventually proceeded to the second stage of surgery.   Conclusion Right-sided PVE was safe and efficacious in this cohort of patients who had previously undergone a complete resection of liver segments II and III as part of a major staged hepatectomy pathway leaving only segments IV(±I) as the FLR. 

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Biliary Cystadenocarcinoma: An Unusual Cause for Recurrent Hemobilia

International Surgery ◽

10.9738/intsurg-d-14-00101.1 ◽

2015 ◽

Vol 100 (4) ◽

pp. 702-704 ◽

Cited By ~ 3

Author(s):

Sunu Philip ◽

Armin Kamyab ◽

Michael Jacobs

Keyword(s):

Liver Function ◽

Biliary Tract ◽

Liver Tumors ◽

Liver Function Tests ◽

Abnormal Liver Function ◽

Function Tests ◽

Uncommon Presentation ◽

Biliary Cystadenocarcinoma ◽

Right Lobe ◽

Primary Presentation

Hemobilia is an uncommon presentation of biliary tract or pancreatic disease. The investigation and management of this clinical problem is challenging. We report on a case of biliary tract hemorrhage from an otherwise asymptomatic right lobe biliary cystadenocarcinoma and review the literature on this unusual presentation. Hemobilia from primary or secondary liver tumors is not frequently reported in the literature. Hemobilia in this setting is usually observed in association with an obvious liver mass or abnormal liver function tests. This is a report of a case of hemobilia as the primary presentation of a small right lobe cystadenocarcinoma. Literature on the incidence and treatment of hemobilia associated with liver tumors has been reviewed. Hemobilia is investigated and definitively treated with angiography. In our case, initial imaging was equivocal and the lesion was only demonstrated after rebleeding, requiring a second angiogram. Surgical resection of the mass was required for definitive control of bleeding. This case illustrates the difficulties of investigating and treating hemobilia caused by primary or secondary liver tumors. Cystadenocarcinoma of the liver is not a common tumor, and biliary tract hemorrhage as the primary presentation of this tumor in the absence of a significant mass or abnormal liver function tests has not been previously described.

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Dietary restriction of energy and sugar results in a reduction in human cytochrome P450 2E1 activity

British Journal Of Nutrition ◽

10.1017/s0007114599001452 ◽

1999 ◽

Vol 82 (4) ◽

pp. 257-262 ◽

Cited By ~ 11

Author(s):

Isabelle Leclercq ◽

Yves Horsmans ◽

Jean-Pierre Desager ◽

Stanislas Pauwels ◽

André P. Geubel

Keyword(s):

Cytochrome P450 ◽

Liver Function ◽

Dietary Intake ◽

Fatty Liver ◽

Alanine Aminotransferase ◽

Liver Volume ◽

Liver Function Tests ◽

Function Tests ◽

Dietary Sugar ◽

Cyp2e1 Activity

Dietary habits are often considered as a pathogenic factor for fatty liver. The impact of dietary intake and steatosis on drug metabolism remains poorly investigated. Our aim was to assess the effect of dietary intake on in vivo cytochrome P450 (CYP) activities in eleven patients with abnormal liver function tests potentially due to fatty liver and associated with a high-sugar diet. Liver function tests, liver volume, aminopyrine breath test (ABT) and chlorzoxazone (CZ) pharmacokinetics (area under the curve, AUC) which are known to reflect CYP2E1 activity were evaluated before and after 2 months restriction of dietary sugar intake. Features at inclusion were an increased BMI (30·3 (sd 3·2) kg/m2), high hepatic volume (1·96 (sd 0·48) litres), hyperechogenic liver parenchyma, elevated liver enzyme activities (alanine aminotransferase (EC 2.6.1.2) 58·6 (sd 17·4) IU/l with alanine aminotransferase : aspartate aminotransferase (EC 2.6.1.1) ratio > 1), together with a normal ABT value (0·68 (sd 0·21) % specific activity of administered dose of [14C]aminopyrine in breath after 1 h) and a high CYP2E1 activity (CZ AUC 20·3 (sd 7·1) μg/ml per h). A dietary sugar restriction was prescribed. On the basis of repeated interviews by the same dietitian, unaware of any clinical and biochemical data, six patients remained compliant to the diet and exhibited reductions in BMI (P < 0·001), serum alanine aminotransferase (P = 0·008), liver volume (P = 0·002) and CYP2E1 activity (P = 0·007), a significant increase in ABT (P < 0·001) together with the disappearance of liver hyperechogenicity at ultrasound. In contrast, the five non-compliant patients did not show any significant change in any of these variables. In conclusion, CYP2E1 activity is induced in patients with perturbations of liver function tests potentially due to fatty liver. In these patients, effective dietary sugar restriction is associated with a reduction in liver volume, a reduction in CYP2E1 activity and an increased aminopyrine metabolism rate.

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