Assessment of Liver Function

Abstract

The selection and timing of management options for cholangiocarcinoma must necessarily be informed by the function of the liver. The consideration of major resectional hepatic surgery is predicated on the ability of that organ to sustain and recover adequate hepatocyte function and mass, whereas individuals presenting with biliary obstruction may benefit from axial or segmental restoration of bile egress prior to planned therapy. Assessment of liver physiological status therefore guides treatment options for cholangiocarcinoma whether arising in the extrahepatic or intrahepatic components of the biliary system. Ideally, an evaluation of liver function should assess not only ambient homeostatic performance but also the recuperative and regenerative capacity of that organ (the functional reserve) since these restorative processes are less efficient in the severely parenchymal-depleted, diseased or cholestatic state [1, 2]. It should be appreciated however, that when the malignant process is confined to one hemi-liver (or segmental components) there may be no measurable disturbance in serum biochemistry or test-substance handling due to compensation by the unaffected liver, and in this situation techniques that assess hepatocyte status per se may be more informative. In addition to those estimations used for initial evaluation prior to planned therapy, serial or longitudinal studies can be used to monitor hepatic status after intervention and to detect deviation from expected patterns of recovery before these become clinically manifest.