Objective evaluation of liver consistency to estimate hepatic fibrosis andfunctional reserve for hepatectomy

Background: The empiric evaluation of liver consistency is currently used t o plan the surgical strategy. The aim of this study was to verify the feasi bility of the objective measurement of liver consistency and to check its c orrelation with liver fibrosis and liver functional reserve. Study Design: Fifty-two consecutive patients who underwent hepatic resectio ns in our department were enrolled. The indications for liver resection wer e hepatocellular carcinoma in 36 patients, metastatic liver tumors in 12 pa tients, and other conditions in 4 patients. Liver consistency was measured with a new tactile sensor. A fibrosis index was calculated as an expression of the percentage of fibrotic tissue. Liver consistency was compared with the degree of liver fibrosis observed in histologic specimens (fibrosis ind ex) and with liver function parameters. Results: Liver stiffness showed a significant positive correlation with fib rosis index (r = 0.887, p < 0.0001). Liver stiffness also showed significan t positive correlation with the indocyanine green test (r= 0.631, p < 0.000 1) by a univariate analysis. The indocyanine green test and platelet count were independently and significantly associated with liver stiffness by a m ultiple regression analysis. In five patients, the liver stiffness values m easured intraoperatively differed markedly from those expected from the ind ocyanine green test values. In these patients, the operative procedures wer e finally selected based on the liver stiffness measured with the tactile s ensor and good clinical outcomes were obtained. Conclusions: These results show for the first time that liver stiffness can be clinically assessed quantitatively by means of the tactile sensor. The tactile sensor adequately estimates liver stiffness and this estimation is well correlated with liver fibrosis and functional reserve. Liver consisten cy determined objectively in this manner may be useful for optimizing surgi cal decision making. (J Am Cell Surg 2000;191:47-53. (C) 2000 by the Americ an College of Surgeons).