PMC5568863_01
Pre-operative portalvenous phase CT in the axial (A) and coronal (B) plane, demonstrating a large solitary liver metastasis (arrow) subdiaphragmal in segment 7, abutting the diaphragm. In addition, irregularity of the liver capsule can be appreciated, confirmative with known cirrhosis.
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The patient now suffered from a newly diagnosed suspicious lesion in segments VII/VIII of the liver (see Fig. 1).
Intraoperative aspect of severe liver cirrhosis (top row: before resection; bottom row: after resection).
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Hence, tumor resection was approached, which failed in a peripheral hospital due to severe macroscopic liver cirrhosis (see Fig. 2).
Pre- and postoperative LiMAx measurement (black: preoperative day; grey: after resection; DOB: Delta over baseline of CO2 exhalation as a surrogate for methacetin metabolism in the liver).
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This revealed a LiMAx-value of 354 mug/kg/h, which indicates a normal liver function capacity (see Fig. 3). Postoperative LiMAx-test showed a decrease to 281 mug/kg/h (see Fig. 3).
Postoperative course of laboratory findings. ALT shows a peak on POD 2. Quick and bilirubin remain stable.
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Liver enzymes rose to a maximum of 336U/l (GPT; see Fig. 4).