Ann Hepatobiliary Pancreat Surg.  2017 Feb;21(1):1-10. 10.14701/ahbps.2017.21.1.1.

Oral glucose tolerance test for preoperative assessment of liver function in liver resection

• Neethirajan SM
• Rachapoodivenkata RR

• KMID: 2371561
• DOI: http://doi.org/10.14701/ahbps.2017.21.1.1

Abstract

BACKGROUNDS/AIMS
We intended to determine the role of the Oral glucose tolerance test (OGTT), in addition to volumetry, in preoperative assessment of patients undergoing liver resection.
METHODS
This was a prospective study conducted at a tertiary care hospital, between February 2009 and February 2011. OGTT curve (parabolic/linear), linearity index (LI) and Parenchymal Hepatic Resection Rate (PHRR) were correlated with postoperative outcomes in terms of postoperative liver failure (PLF), by 50-50 criteria, morbidity, mortality and hospital stay.
RESULTS
Of the 33 patients included in the study, 23 (69.7%) patients underwent major liver resections. Hepatocellular carcinoma (30.3%) was the leading indication. The overall postoperative morbidity rate was 72.7%, but major complications occurred in 3 (9.1%) patients only. There was no 90-day mortality. The 50-50 criteria were met by 3 patients undergoing major resection. Significant correlation was noted between the linear OGTT curve and the overall hospital stay (12.1 days vs. 9.6 days in parabolic; p=0.04). Patients with linear OGTT met the 50-50 criteria more often (18%) than those having a parabolic curve (4.5%; p=0.25). Although the OGTT was more often linear with occurrence of morbidity (41.7% vs 11.1%), major morbidity (66.7% vs 30%) and PLF by 50-50 criteria (66.7% vs 30%), it was not statistically significant. The linearity index was marginally lower (0.9 vs 1.2) in the presence of major morbidity and PLF by 50-50 criteria.
CONCLUSIONS
Linear OGTT affects the PLF and major morbidity, therein impacting the hospital stay. OGTT LI and PHRR can help predict postoperative outcome for a given extent of liver resection.

Keyword

Oral glucose tolerance test; Volumetry; Postoperative liver failure; Liver resection; Hepatectomy

MeSH Terms

Carcinoma, Hepatocellular
Glucose Tolerance Test*
Hepatectomy
Humans
Length of Stay
Liver Failure
Liver*
Mortality
Prospective Studies
Tertiary Healthcare

Figure

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  Fig. 1 Representative parabolic (A) and linear (B) oral glucose tolerance test (OGTT) curves.

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  Fig. 2 Outcomes in group with parenchymal hepatic resection rate (PHRR) >50%.

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  Fig. 3 Outcomes in group with parenchymal hepatic resection rate (PHRR) <50%.

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