Abstract 3706: Feasibility of Methacetin C13 breath test in assessing liver function in patient who had liver resection due to HCC

Abstract Aim: Our aim was to assess the feasibility of Methacetin breath tests in decreasing mortality during or after liver resection, predict complications and liver failure after the resection. Method: Methacetin C13 breath test was kindly donated by Beijing Richen Science and Technology Co., Ltd. 10 empty breaths were collected before each measurement and 75mg/80ml methacetin was orally administered. After administration 9 breaths at 10, 20, 30, 40, 50, 60, 80, 100 and 120 minutes were collected in the bags provided by the manufacturer. Breath test was performed on the day before operation, post operation days 1 and 10. Patients with projected resection of more than 20% of the liver were included in the study. Additional parameters like liver enzymes, Child-Pugh score, platelets, albumin, CT volumetry were assessed. Total of 42 patients were included in the study, out of which 5 were healthy controls. 23 patients canceled operation because of insufficient liver function. 14 patients participated until the last measurement of day 10 at National Cancer Center of Mongolia. Three parameters of the methacetin breath test: methacetin concentration after 30 min of administration CUM30, highest concentration of methacetin DOB peak, and calculated liver function using the software provided by the manufacturer were obtained after each measurement. Result: 5 healthy controls had the mean DOB peak value of 29.056, CUM30 of 91.56 and liver function 114. When 20% of the liver was resected Methacetin concentration was decreased by 47.09% (DOB peak), 72.1% (CUM30), 63.22% (calc. liver function); when 35% resected 45.33%, 73.35%, and 74.28%; when 40% cut: 39.04%, 99.3%, 99.3%; when 50% cut 67.38%, 81.97%, 75.2%; when 65% cut: values were 37.51%, 54.27% and 42.97% respectively. All patients were Child-Pugh A, and mean albumin was 3.8 g/dl and platelets were 229X109/L, ALT 179IU/L and AST 162IU/L respectively. In terms of predicting complications we observed DOB peak has the most meaningful results with 5 out of 6 patients with post operative complications had a value of <20, while 6 out of 7 patients without complications had values >20. Conclusion: The closest parameter to the amount of liver resected was the highest concentration of methacetin DOB peak, whereas CUM 30 and liver function did not match the amount as that of DOB peak. We suggest the cut off value of DOB peak at 20. This method is non-invasive, non-toxic, direct method to assess liver function with high predictive and dynamic range in regard to residual liver function. The sensitivity of the methacetin test to predict post-operative complications were 83%, and the specificity stands at 85% with PPV (Positive Predictive Value)=83%, and NPV (Negative Predictive Value)=85% respectively. The most common post-operative complications we encountered were ascitis and wound infections. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 3706. doi:1538-7445.AM2012-3706