BACKGROUND: Liver failure has remained a major cause of mortality after 
hepatectomy, but it is difficult to predict preoperatively. This study describes 
the introduction into clinical practice of the new LiMAx test and provides an 
algorithm for its use in the clinical management of hepatic tumours.
METHODS: Patients with hepatic tumours and indications for hepatectomy were 
investigated perioperatively with the LiMAx test. In one patient, analysis of 
liver volume was carried out with preoperative three-dimensional virtual 
resection.
RESULTS: A total of 329 patients with hepatic tumours were evaluated for 
hepatectomy. Blinded preoperative LiMAx values were significantly higher before 
resection (n= 139; mean 351 microg/kg/h, range 285-451 microg/kg/h) than before 
refusal (n= 29; mean 299 microg/kg/h, range 223-376 microg/kg/h; P= 0.009). 
In-hospital mortality rates were 38.1% (8/21 patients), 10.5% (2/19 patients) 
and 1.0% (1/99 patients) for postoperative LiMAx of <80 microg/kg/h, 80-100 
microg/kg/h and >100 microg/kg/h, respectively (P < 0.0001). A decision tree was 
developed to avoid critical values and its prospective preoperative application 
revealed a reduction in mortality from 9.4% to 3.4% (P= 0.019).
DISCUSSION: The LiMAx test can validly determine liver function capacity and is 
feasible in every clinical situation. Combination with virtual resection could 
enable the calculation of residual liver function. The LiMAx decision tree 
algorithm for hepatectomy might significantly improve preoperative evaluation 
and postoperative outcome in liver surgery.