The role of hepatobiliary scintigraphy combined with spect/ct in predicting severity of liver failure before major hepatectomy: a single-center pilot study

Abstract Hepatobiliary scintigraphy (HBS) has been demonstrated to predict post-hepatectomy liver failure (PHLF). However, existing cutoff values for future liver remnant function (FLR-F) were previously set according to the “50–50 criteria” PHLF definition. Methods of calculation and fields of application in liver surgery have changed in the meantime. The aim of this study was to demonstrate the role of HBS combined with single photon emission computed tomography (SPECT/CT) in predicting severity of PHLF, according to the International Study Group of Liver Surgery (ISGLS). All patients submitted to major hepatectomy with preoperative HBS-SPECT/CT between November 2016 and December 2019, were analyzed. Patients were resected according to hepatic volumetry. Receiver operating characteristic (ROC) curve analysis was performed to identify cutoffs of FLR function for predicting PHLF according to ISGLS definition and grading. Of the 38 patients enrolled, 26 were submitted to one-stage hepatectomy (living liver donors = 4) and 12 to two-stage procedures (portal vein embolization = 4, ALPPS = 8). Overall, 18 patients developed PHLF according to ISGLS criteria: 12 of grade A (no change in the patient’s clinical management) and 6 of grade B (change in clinical management). ROC analysis established increasingly higher cutoffs of FLR-F for predicting PHLF according to the “50–50 criteria”, ISGLS grade B and ISGLS grade A/B, respectively. HBS with SPECT/CT may help to assess severity of PHLF following major hepatectomy. Prospective multicenter trials are needed to confirm the effective role of HBS-SPECT/CT in liver surgery.

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Major Hepatectomy in a Child with Extremely Low Future Liver Remnant Without Posthepatectomy Liver Failure

HPB ◽

10.1016/j.hpb.2020.11.502 ◽

2021 ◽

Vol 23 ◽

pp. S201

Author(s):

D. Akhaladze ◽

D. Kachanov ◽

G. Rabaev ◽

N. Merkulov ◽

N. Uskova ◽

...

Keyword(s):

Liver Failure ◽

Major Hepatectomy ◽

Future Liver Remnant ◽

Liver Remnant ◽

Posthepatectomy Liver Failure

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Initial evaluation of the protocol for the liver remnant after major hepatectomies with liver volumetry using ct and funtionality with single photon emission computed tomography-hepatobiliary scintigraphy (mtc99-mebrofenin)

HPB ◽

10.1016/j.hpb.2019.10.1951 ◽

2019 ◽

Vol 21 ◽

pp. S350

Author(s):

MIkel Prieto ◽

Mikel Gastaca ◽

Ibone Palomares ◽

Pablo Mínguez ◽

Patricia Ruiz ◽

...

Keyword(s):

Single Photon ◽

Photon Emission ◽

Emission Computed Tomography ◽

Hepatobiliary Scintigraphy ◽

Single Photon Emission ◽

Liver Remnant ◽

Liver Volumetry ◽

Single Photon Emission Computed ◽

Major Hepatectomies ◽

Photon Emission Computed Tomography

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Portal Vein Embolization with PVA and Coils before Major Hepatectomy: Single-Center Retrospective Analysis in Sixty-Four Patients

Journal of Oncology ◽

10.1155/2019/4634309 ◽

2019 ◽

Vol 2019 ◽

pp. 1-9 ◽

Cited By ~ 1

Author(s):

R. Camelo ◽

J. H. Luz ◽

F. V. Gomes ◽

E. Coimbra ◽

N. V. Costa ◽

...

Keyword(s):

Portal Vein ◽

Liver Tumor ◽

Portal Vein Embolization ◽

Liver Surgery ◽

Major Hepatectomy ◽

Tumor Resection ◽

Future Liver Remnant ◽

Mean Value ◽

Liver Remnant ◽

Hepatic Artery Branch

Objectives. Portal vein embolization (PVE) stimulates hypertrophy of the future liver remnant (FLR) and improves the safety of extended hepatectomy. This study evaluated the efficacy of PVE, performed with PVA and coils, in relation to its effect on FLR volume and ratio. Secondary endpoints were the assessment of PVE complications, accomplishment of liver surgery, and patient outcome after hepatectomy. Materials and Methods. All patients who underwent PVE before planned major hepatectomy between 2013 and 2017 were retrospectively analyzed, comprising a total of 64 patients. Baseline patient clinical characteristics, imaging records, liver volumetric changes, complications, and outcomes were analyzed. Results. There were 45 men and 19 women with a mean age of 64 years. Colorectal liver metastasis was the most frequent liver tumor. The majority of patients (n = 53) had a right PVE. FLR increased from a mean value of 484 ml ± 242 to 654 ml ± 287 p<0.001 after PVE. Two major complications were experienced after PVE: 1 case of left hepatic artery branch laceration and 1 case of hemoperitoneum and hemothorax. A total of 44 (69%) patients underwent liver surgery. Twenty-one patients were not taken to surgery due to disease progression (n = 18), liver insufficiency (n = 1), and insufficient FLR volume (n = 1), and one patient declined surgery (n = 1). Conclusions. PVE with PVA and coils was accomplished safely and promoted a high FLR hypertrophy yield, enabling most of our patients to be submitted to the potentially curative treatment of liver tumor resection.

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Assessment of Liver Remnant Using ICG Clearance Intraoperatively during Vascular Exclusion: Early Experience with the ALIIVE Technique

HPB Surgery ◽

10.1155/2015/757052 ◽

2015 ◽

Vol 2015 ◽

pp. 1-9 ◽

Cited By ~ 2

Author(s):

Lawrence Lau ◽

Christopher Christophi ◽

Mehrdad Nikfarjam ◽

Graham Starkey ◽

Mark Goodwin ◽

...

Keyword(s):

Liver Failure ◽

Major Hepatectomy ◽

Significant Risk ◽

Future Liver Remnant ◽

Preoperative Assessment ◽

Parenchymal Transection ◽

Liver Remnant ◽

Posthepatectomy Liver Failure ◽

Vascular Exclusion ◽

Icg Clearance

Background. The most significant risk following major hepatectomy is postoperative liver insufficiency. Current preoperative assessment of the future liver remnant relies upon assumptions which may not be valid in the setting of advanced resection strategies. This paper reports the feasibility of the ALIIVE technique which assesses the liver remnant with ICG clearance intraoperatively during vascular exclusion. Methods. 10 patients undergoing planned major liver resection (hemihepatectomy or greater) were recruited. Routine preoperative assessment included CT and standardized volumetry. ICG clearance was measured noninvasively using a finger spectrophotometer at various time points including following parenchymal transection during inflow and outflow occlusion before vascular division, the ALIIVE step. Results. There were one case of mortality and three cases of posthepatectomy liver failure. The patient who died had the lowest ALIIVE ICG clearance (7.1%/min versus 14.4 ± 4.9). Routine preoperative CT and standardized volumetry did not predict outcome. Discussion/Conclusion. The novel ALIIVE technique is feasible and assesses actual future liver remnant function before the point of no return during major hepatectomy. This technique may be useful as a check step to offer a margin of safety to prevent posthepatectomy liver failure and death. Further confirmatory studies are required to determine a safety cutoff level.

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