Post Hepatectomy Liver Failure: Risk Factors and Prediction of Post-Operative Function using Novel Dynamic MRI

Liver surgery is an advancing specialty with improved outcomes in recent years. Liver resection is used with curative intent for both primary and metastatic cancer. Despite the rapid improvements and increasing range of surgical options, there remains a significant risk of developing Post-Hepatectomy Liver Failure (PHLF) – caused by inadequate remnant liver function after surgery. This is a condition with high mortality and morbidity and currently there are no specific treatments for it once it has developed. Its pathogenesis is complex and multifactorial, and some risk factors, particularly ageing are uncertain as to their contributing significance. This thesis aimed to investigate risk factors for PHLF development and a imaging based measurement of liver function after major liver resection. This study identified patients over-75 years have a significantly increased risk of PHLF.
Development of a method to predict post-operative function is needed to aid patient selection and reduce complications for those who undergo resection. Currently, volumetry is performed but this has proven inadequate, with some patients still developing PHLF despite adequate remnant volume. Other options such as Indocyanine Green and Technetium-99m labelled Mebrofenin are not readily available. One potential solution is Dynamic Gadoxetate Enhanced (DGE) MRI of the Liver, which has been developed to investigate liver function, with promising results for demonstrating liver heterogenicity in patients with parenchymal liver diseases. Oncological staging of the liver involves MRI to plan surgical resection, and DGE-MRI can be integrated into the diagnostic protocol easily with no additional burden to the patient. This thesis aimed to demonstrate if DGE-MRI functional estimates can predict post-operative liver function after resection of colorectal liver metastases. This study demonstrated that there was good correlation of DGE-MRI-function tests with post-operative hyperbilirubinaemia, a measure of hepatic dysfunction. This could be utilised in surgical planning to improve patient selection and outcomes.