Liver Function Assessment in Oncology: Current Tools for Evaluating Hepatic Reserve and Surgical Decision-Making
4 affiliations
- 1Unit of Hepato-Biliary and Pancreatic Surgery, “F. Miulli” General Hospital, 70021 Acquaviva delle Fonti, Italy
- 2Department of Medicine and Surgery, LUM University, 70010 Casamassima, Italy
- 3Transplant and HPB Unit, Department of Surgery Sciences, University of Rome Tor Vergata, 00133 Rome, Italy
- 4Unit of Interventional Radiology, “F. Miulli” General Hospital, 70021 Acquaviva delle Fonti, Italy
Abstract
Accurate assessment of hepatic functional reserve is essential in patients with primary or secondary liver malignancies undergoing liver resection, particularly in the presence of chronic liver disease, chemotherapy-associated liver injury, cholestasis, or portal hypertension. Conventional laboratory parameters and clinical scores, including Child-Pugh, MELD, ALBI, and the combined APRI/ALBI score, provide accessible measures of global hepatic status and risk stratification but do not directly quantify regional function or dynamic metabolic capacity. Complementary approaches include indocyanine green clearance, LiMAx testing, liver stiffness measurement, hepatobiliary scintigraphy, gadoxetic acid-enhanced magnetic resonance imaging, and CT/MRI-based future liver remnant volumetry. This narrative review critically examines the strengths, limitations, and clinical applicability of these modalities in the context of contemporary evidence and recommendations. Building on, but extending beyond, the 2023 E-AHPBA-ESSO-ESSR Innsbruck consensus, we incorporate subsequent comparative evidence on blood-based scores and functional imaging and discuss emerging approaches including longitudinal assessment, radiomics, and artificial intelligence. Current evidence supports an individualized, multimodal strategy in which volumetry remains central to surgical planning, while additional functional and portal-hypertension assessment is selected according to the extent of resection, underlying parenchymal disease, previous treatment, and local expertise. No single modality or fixed combination can currently be considered universally superior, highlighting the need for prospective validation of integrated and cost-effective assessment strategies.
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BibTeX
@article{caringi2026liver,
title = {{Liver Function Assessment in Oncology: Current Tools for Evaluating Hepatic Reserve and Surgical Decision-Making}},
author = {Silvio Caringi and Antonella Delvecchio and Annachiara Casella and Valentina Ferraro and Matteo Stasi and Nunzio Tralli and Tommaso Maria Manzia and Riccardo Inchingolo and Michele Tedeschi and Riccardo Memeo},
journal = {Journal of Clinical Medicine},
year = {2026},
month = oct,
doi = {10.3390/jcm15208003},
url = {https://www.mdpi.com/2077-0383/15/20/8003},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Liver Function Assessment in Oncology: Current Tools for Evaluating Hepatic Reserve and Surgical Decision-Making
AU - Silvio Caringi
AU - Antonella Delvecchio
AU - Annachiara Casella
AU - Valentina Ferraro
AU - Matteo Stasi
AU - Nunzio Tralli
AU - Tommaso Maria Manzia
AU - Riccardo Inchingolo
AU - Michele Tedeschi
AU - Riccardo Memeo
PY - 2026
DA - 2026/10/01
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15208003
UR - https://www.mdpi.com/2077-0383/15/20/8003
AB - Accurate assessment of hepatic functional reserve is essential in patients with primary or secondary liver malignancies undergoing liver resection, particularly in the presence of chronic liver disease, chemotherapy-associated liver injury, cholestasis, or portal hypertension. Conventional laboratory parameters and clinical scores, including Child-Pugh, MELD, ALBI, and the combined APRI/ALBI score, provide accessible measures of global hepatic status and risk stratification but do not directly quantify regional function or dynamic metabolic capacity. Complementary approaches include indocyanine green clearance, LiMAx testing, liver stiffness measurement, hepatobiliary scintigraphy, gadoxetic acid-enhanced magnetic resonance imaging, and CT/MRI-based future liver remnant volumetry. This narrative review critically examines the strengths, limitations, and clinical applicability of these modalities in the context of contemporary evidence and recommendations. Building on, but extending beyond, the 2023 E-AHPBA-ESSO-ESSR Innsbruck consensus, we incorporate subsequent comparative evidence on blood-based scores and functional imaging and discuss emerging approaches including longitudinal assessment, radiomics, and artificial intelligence. Current evidence supports an individualized, multimodal strategy in which volumetry remains central to surgical planning, while additional functional and portal-hypertension assessment is selected according to the extent of resection, underlying parenchymal disease, previous treatment, and local expertise. No single modality or fixed combination can currently be considered universally superior, highlighting the need for prospective validation of integrated and cost-effective assessment strategies.
SN - 2077-0383
ER -