Abstract:
Liver cancer is the sixth most prevalent malignant tumor and the third leading cause of cancer-related deaths worldwide. Although liver resection surgery remains the primary radical treatment for liver cancer, with high efficacy, the prognosis for some patients is not ideal. Post-hepatectomy liver failure (PHLF) is one of the major causes of death during the perioperative period. The occurrence of PHLF is closely related to insufficient volume and function of the remnant liver after hepatectomy. Therefore, accurate assessment of preoperative liver reserve function is crucial. However, the progression of chronic liver disease can cause changes in hepatic functional reserve, and there are differences in function in different regions of the liver, posing significant challenges to accurate preoperative assessment. Currently, common methods for assessing liver reserve function include comprehensive scoring systems, laboratory serological tests, indocyanine green (ICG) clearance test, imaging, and nuclear medicine hepatobiliary scintigraphy. Serological tests and clinical scoring systems are commonly used tools for screening hepatic insufficiency, with low cost and easy accessibility, and are widely used in clinical practice. Currently, the ICG clearance test has been included in guidelines and expert consensus in China, but its evaluation is still for overall liver function. Gd-EOB-DTPA is a hepatobiliary-specific MRI contrast agent that not only provides anatomical information but also allows quantitative assessment of local liver function. Compared to the ICG clearance test, Gd-EOB-DTPA-enhanced MRI has higher predictive value for PHLF. However, factors such as high cost, lengthy examination processes, and complex scanning sequence parameter adjustment limit the widespread application of this technology. With the continued advancement of the concept of precision medicine, the widespread use of three-dimensional imaging technology has important clinical value in guiding precise surgical operations, improving surgical accuracy, and safety. In recent years, with the rapid development of artificial intelligence (AI) in the medical field, AI-assisted three-dimensional reconstruction can significantly shorten processing time and improve measurement accuracy. It is worth noting that three-dimensional imaging technology is based on the overall assessment of liver volume, and the remnant liver volume and function do not exactly correspond with each other. CT perfusion imaging, with its wide scanning range, high spatial resolution, and accurate blood flow measurement capabilities, is an ideal tool for liver function assessment. However, the limitations such as CT radiation exposure and poor reproducibility prevent the routine application of this technique. Elastography, as a non-invasive method, assesses the degree of liver fibrosis in patients with chronic liver disease by measuring liver stiffness, indirectly achieving the assessment of liver reserve function. The advantage of hepatobiliary scintigraphy lies in its abilities to assess both overall and regional liver function, combine with SPECT/CT for volume assessment, and consider intersegmental functional variability and potential pathological conditions. However, its current application in China is still limited, requiring further exploration of its clinical value. Currently, commonly used assessment methods still cannot comprehensively and accurately reflect liver reserve function, and all have their limitations. This article reviews the latest research progress on preoperative liver reserve function assessment methods in liver cancer, aiming to provide a scientific basis and guidance for clinical practice.
