Evaluation of preoperative portal embolization for safe hepatectomy, with special reference to assessment of nonembolized lobe function with 99mTc-GSA SPECT scintigraphy

Hirai, Ichiro; Kimura, Wataru; Fuse, Akira; Suto, Koichi; Urayama, Masahiro

doi:10.1067/msy.2003.138

Cited by 92 publications

(78 citation statements)

References 25 publications

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“…6 Two additional studies from Japan confirmed that the increase in FRL function after PVE measured by technetium-99 m ( 99m Tc)-galactosyl-human serum albumin (GSA) scintigraphy exceeds the increase in volume in cirrhotic and noncirrhotic patients. 3,65 This implies that the recommended waiting time until operation may be shorter than suggested by volumetric studies, which is more favorable in light of the risk of tumor progression after PVE.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5][6] Portal vein occlusion by either embolization (PVE) or ligation (PVL) has proven useful to reduce risk of postoperative liver dysfunction and enables resection in patients previously deemed unresectable due to a marginal FRL. [7][8][9][10][11][12][13][14] FRL volume smaller than 25-30% of total preoperative liver volume is generally considered insufficient in patients with normal liver parenchyma.…”

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confidence: 99%

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Induction of Tumor Growth After Preoperative Portal Vein Embolization: Is It a Real Problem?

et al. 2008

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Although preoperative portal vein embolization (PVE) is an effective means to increase future remnant liver (FRL) volume, little has been published on possible adverse effects. This review discusses the clinical and experimental evidence regarding the effect of PVE on tumor growth in both embolized and nonembolized liver lobes, as well as potential strategies to control tumor progression after PVE. A literature review was performed using MEDLINE with keywords related to experimental and clinical studies concerning PVE, portal vein ligation (PVL), and tumor growth. Cross-references and references from reviews were also checked. Clinical and experimental data suggest that tumor progression can occur after preoperative PVE in embolized and nonembolized liver segments. Clinical evidence indicating possible tumor progression in patients with colorectal metastases or with primary liver tumors is based on studies with small sample size. Although multiple studies demonstrated tumor progression, evidence concerning a direct increase in tumor growth rate as a result of PVE is circumstantial. Three possible mechanisms influencing tumor growth after PVE can be recognized, namely changes in cytokines or growth factors, alteration in hepatic blood supply and an enhanced cellular host response promoting local tumor growth after PVE. Post-PVE chemotherapy and sequential transcatheter arterial chemoembolization (TACE) before PVE have been proposed to reduce tumor mass after PVE. We conclude that tumor progression can occur after PVE in patients with colorectal metastases as well as in patients with primary liver tumors. However, further research is needed in order to rate this risk of tumor progression after PVE.Preoperative portal vein embolization (PVE) is an accepted intervention in patients requiring major liver resection in whom the estimated future remnant liver (FRL) is too small to allow safe resection.1,2 PVE induces atrophy of the embolized, tumor-bearing liver lobe while compensatory hypertrophy of the nonembolized lobe occurs, thereby increasing FRL volume and function.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Induction of Tumor Growth After Preoperative Portal Vein Embolization: Is It a Real Problem?

et al. 2008

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“…In cirrhotic and noncirrhotic patients, the increase in FRL function after PVE was more pronounced compared to the volumetric increase measured with CT volumetry [66,67]. Currently, changes in the FRL after PVE are monitored by CT volumetry, implying that GSA could be of additional value in the management of patients who undergo PVE because of insufficient FRL.…”

Section: Scintigraphic Liver Function Testsmentioning

confidence: 99%

New Perspectives in the Assessment of Future Remnant Liver

Cieslak¹,

Runge

Heger³

et al. 2014

Dig Surg

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In order to achieve microscopic radical resection margins and thus better survival, surgical treatment of hepatic tumors has become more aggressive in the last decades, resulting in an increased rate of complex and extended liver resections. Postoperative outcomes mainly depend on the size and quality of the future remnant liver (FRL). Liver resection, when performed in the absence of sufficient FRL, inevitably leads to postresection liver failure. The current gold standard in the preoperative assessment of the FRL is computed tomography volumetry. In addition to the volume of the liver remnant after resection, postoperative function of the liver remnant is directly related to the quality of liver parenchyma. The latter is mainly influenced by underlying diseases such as cirrhosis and steatosis, which are often inaccurately defined until microscopic examination after the resection. Postresection liver failure remains a point of major concern that calls for accurate methods of preoperative FRL assessment. A wide spectrum of tests has become available in the past years, attesting to the fact that the ideal methodology has yet to be defined. The aim of this review is to discuss the current modalities available and new perspectives in the assessment of FRL in patients scheduled for major liver resection. i 2014 S. Karger AG, Basel

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“…Preoperative functional volume measured by 99m Tc-GSA SPECT proved more suitable for predicting remnant liver function than did CT volumetry in a study group with predominantly cirrhotic patients (33,44). Although the outline extraction method is regularly used to calculate functional hepatic volume (33,44,(52)(53)(54), that method is based on the assumption that liver function is uniformly distributed in the tissue included within the cutoff value. Especially in tumor-bearing and compromised livers, function is not distributed homogeneously.…”

Section: Kinetics and Quantitative Measurement Of Liver Functionmentioning

confidence: 99%

“…Several studies evaluated increased FRL function after PVE using 99m Tc-GSA scintigraphy (46,(53)(54)(55)(56)(57). In 2 studies, the increase in FRL function after PVE was measured by dynamic 99m Tc-GSA SPECT and was compared with an increase in FRL volume, measured by CT volumetry, in cirrhotic and noncirrhotic patients (53,57). The increase in FRL function (expressed as liver uptake ratio, liver uptake density, residual functional liver volume, and predictive residual index) was more extensive than the increase in FRL volume, indicating that 99m Tc-GSA scintigraphy has additional value over CT volumetry for evaluating the functional increase in FRL after PVE.…”

Section: Kinetics and Quantitative Measurement Of Liver Functionmentioning

confidence: 99%

Nuclear Imaging Techniques for the Assessment of Hepatic Function in Liver Surgery and Transplantation

Graaf¹,

Bennink²,

Veteläinen³

et al. 2010

J Nucl Med

135

120

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This review describes the application of 2 nuclear imaging techniques for assessment of hepatic function in the setting of liver surgery and transplantation. The biochemical and technical background, as well as the clinical applications, of 99m Tc-labeled diethylenetriaminepentaacetic acid galactosyl human serum albumin (GSA) scintigraphy and hepatobiliary scintigraphy (HBS) with 99m Tc-labeled iminodiacetic acid derivates is discussed. 99m Tc-mebrofenin is considered the most suitable iminodiacetic acid agent for 99m Tc-HBS. 99m Tc-GSA scintigraphy and 99m Tcmebrofenin HBS are based on 2 different principles. 99m Tc-GSA scintigraphy is a receptor-mediated technique whereas HBS represents hepatic uptake and excretion function. Both techniques are noninvasive and provide visual and quantitative information on both total and regional liver function. They can be used for preoperative assessment of future remnant liver function, follow-up after preoperative portal vein embolization, and evaluation of postoperative liver regeneration. In liver transplantation, these methods are used to assess graft function and biliary complications.

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Evaluation of preoperative portal embolization for safe hepatectomy, with special reference to assessment of nonembolized lobe function with 99mTc-GSA SPECT scintigraphy

Cited by 92 publications

References 25 publications

Induction of Tumor Growth After Preoperative Portal Vein Embolization: Is It a Real Problem?

Induction of Tumor Growth After Preoperative Portal Vein Embolization: Is It a Real Problem?

New Perspectives in the Assessment of Future Remnant Liver

Nuclear Imaging Techniques for the Assessment of Hepatic Function in Liver Surgery and Transplantation

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