Z Gastroenterol 2016; 54(12): 1343-1404
DOI: 10.1055/s-0036-1597478
4. Tumors/Liver Surgery
Georg Thieme Verlag KG Stuttgart · New York

Improved perioperative management using LiMAx test in liver surgery – preliminary results from the randomized Fast-track LiveR trial

JF Lock
1   University Hospital of Würzburg, Department of General-, Visceral-, Vascular- and Paediatric Surgery, Würzburg, Germany
,
FW Vondran
2   Hannover Medical School, Department of General, Visceral and Transplant Surgery, Hannover, Germany
,
U Settmacher
3   University of Jena, Department of General, Visceral and Vascular Surgery, Jena, Germany
,
HM Tautenhahn
4   University Hospital Leipzig, Department of General, Visceral, Thoracic and Transplant Surgery, Leipzig, Germany
,
H Lang
5   Johannes Gutenberg University, Department of Hepatobiliary and Transplantation Surgery, Mainz, Germany
,
J Pratschke
6   Charité-Universitätsmedizin Berlin, General, Visceral, and Transplantation Surgery, Berlin, Germany
,
CT Germer
1   University Hospital of Würzburg, Department of General-, Visceral-, Vascular- and Paediatric Surgery, Würzburg, Germany
,
I Klein
1   University Hospital of Würzburg, Department of General-, Visceral-, Vascular- and Paediatric Surgery, Würzburg, Germany
,
M Stockmann
6   Charité-Universitätsmedizin Berlin, General, Visceral, and Transplantation Surgery, Berlin, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
19 December 2016 (online)

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Background: The LiMAx test can validly determine liver capacity and has been successfully integrated in clinical management in liver surgery. However, no prospective randomized trials have been available to judge its actual clinical impact.

Methods: A randomized controlled trial (RCT) was conducted during January 2013 to September 2015 in six recruiting clinics. Patients prior open liver resection of at least one segment were included. Patients were randomly assigned to LiMAx group (pre-, and postoperative LiMAx test) or control group (standard-of-care). Stable patients with sufficient residual liver function (LiMAx > 150 µg/kg/h) were directly transferred to general ward after surgery.

Results: A total of 148 patients were randomized. Patients in LiMAx group were more frequently directly transferred to general ward after surgery (62.1% vs. 1.7%; p < 0.0001), the risk of severe postoperative complications was lower (grade IIIa; 14% vs. 28%; p < 0.02) and the length of post-operative stay was shorter (10 vs. 13 days; p = 0.01). No patient in LiMAx group was admitted to intensive care after primary transfer to general ward.

Conclusion: The LiMAx test distinctively improves perioperative management in liver surgery. The valid identification of low risk patients skipping intensive care enables enhanced recovery.