Ultrasound and biochemical evaluation of liver regeneration process after resections for primary and metastatic tumors

BACKGROUND/AIMS: The liver regeneration process after resective procedures is an important clinical problem especially in view of the growing population of patients requiring liver transplantations or undergoing resective procedures as well as those with toxic or viral liver injures. The aim of the study was to analyze liver regeneration potential using ultrasound examination, and liver function biochemical tests in the patients after liver resections. METHODOLOGY: Twenty-one patients with primary or metastatic liver cancer were included in the study (17 males, 4 females, mean age: 59.8, SD 10.3). The patients were undergoing gastrointestinal tract primary tumor resections with extended lymphadenectomy and liver metastatic tumor excisions. Liver volume was measured postoperatively in the follow-up ultrasound examinations and biochemical tests were performed before and after the procedure. Liver function and activity of p-450 cytochrome was tested with IRIS 13C stable isotope breath analyzer. RESULTS: The mean time of follow-up was 12.6 months (SD 7.8) during which volume of liver increased on average in the first five months to 105.7, 112.1, 125.7, 131.2, and 138.4% of the immediate postoperative value. Biochemical parameters returned to normal after 2-3 weeks. Four patients in whom liver failed to regenerate died due to cancer spread in the mean time of 6.5 months. CONCLUSIONS: Liver has tremendous regeneration potential. In spite of this fact, extended hepatectomies affect largely the functional status of residual parenchyma which may lead to a fatal outcome.