Rahimli Mirhasan, Perrakis Aristotelis, Gumbs Andrew A, Andric Mihailo, Al-Madhi Sara, Arend Joerg, Croner Roland S
Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany.
Department of Surgery, Centre Hospitalier Intercommunal de Poissy/Saint-Germain-en-Laye, 10 Rue du Champ Gaillard, 78300 Poissy, France.
J Clin Med. 2022 May 27;11(11):3018. doi: 10.3390/jcm11113018.
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.
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.
Forty patients were selected from the MD-MILS regarding the selection criteria (LiMAx normal, = 22 and LiMAx decreased, = 18). Significantly more major liver resections were performed in the LiMAx normal vs. the LiMAx decreased group (13 vs. 2; = 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; = 0.003) and the intraoperative blood transfusion significantly higher in the LiMAx normal vs. the LiMAx decreased group (8 vs. 1; = 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.
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.
肝衰竭是肝脏手术后相关发病率和死亡率的关键预测指标。因此，进行良好的患者选择至关重要。我们在机器人和腹腔镜肝脏手术中使用LiMAx检测来选择接受大或小肝切除术的患者，并在此分享我们的经验。
我们在马格德堡微创肝脏手术登记处（MD-MILS）中确定了接受机器人或腹腔镜小或大肝脏手术并接受LiMAx检测以进行术前肝功能评估的患者。该队列分为两组：LiMAx检测肝功能正常（LiMAx正常）和降低（LiMAx降低）的患者。
根据选择标准从MD-MILS中选出40例患者（LiMAx正常，n = 22；LiMAx降低，n = 18）。LiMAx正常组与LiMAx降低组相比，进行大肝切除术的比例明显更高（13例对2例；P = 0.003）。因此，LiMAx正常组的平均手术时间明显长于LiMAx降低组（356.6分钟对228.1分钟；P = 0.0
