Functional assessment versus conventional volumetric assessment in the prediction of operative outcomes after major hepatectomy

Hayashi, Hiromitsu; Beppu, Teruhiko; Okabe, Hidetoshi; Kuroki, Hideyuki; Nakagawa, Shigeki; Imai, Katsunori; Nitta, Hidetoshi; Chikamoto, Akira; Ishiko, Takatoshi; Baba, Hideo

doi:10.1016/j.surg.2014.06.013

Cited by 72 publications

(81 citation statements)

References 19 publications

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“…Some studies have reported that volumetric measurement by 99m Tc-GSA scintigraphy was useful for detecting changes in the functional volume of the individual lobes of the liver and is a more dynamic method than detection of morphologic changes by CT scan after portal vein embolization [33, 39, 40]. Although data on regional hepatic function can be obtained from 99m Tc-GSA SPECT or fusion images via 99m Tc-GSA SPECT/CT [19-21], LHL15 is easier to calculate and is the most commonly used parameter in 99m Tc-GSA scintigraphy [14, 22]. Moreover, remnant LHL15 can be also calculated using LHL15 and CT volume data.…”

Section: Discussionmentioning

confidence: 99%

“…Yoshida et al [49] mentioned that although HH15 and LHL15 were useful indices of preoperative functional reserve of the liver, the anatomical information that they provide was not sufficient to accurately assess the function of the future remnant liver. Therefore, HH15 and LHL15 are usually used with CT volumetry data, such as those obtained from 99m Tc-GSA SPECT or from fusion images via 99m Tc-GSA SPECT/CT [19-21]. …”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have reported the clinical usefulness of a 99m Tc-GSA single-photon emission computed tomography (SPECT)/ computed tomography (CT) fusion imaging to evaluate regional hepatic function and predict postoperative hepatic functional reserve [19-21]. Meanwhile, the hepatic uptake ratio (uptake ratio of the liver to the liver and heart at 15 min; LHL15) and blood clearance ratio (uptake ratio of the heart at 15 min to that at 3 min; HH15) of 99m Tc-GSA are the most commonly used parameters, as they can be easily obtained [14, 22].…”

Section: Introductionmentioning

confidence: 99%

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Impaired Value of 99m Tc-GSA Scintigraphy as an Independent Risk Factor for Posthepatectomy Liver Failure in Patients with Hepatocellular Carcinoma

et al. 2018

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Background: Posthepatectomy liver failure (PHLF) was recently defined with the corresponding recommendations as follows: grade A, no change in clinical management; grade B, clinical management with noninvasive treatment; and grade C, clinical management with invasive treatment. In this study, we identified the risk factors for grade B and C PHLF in patients with hepatocellular carcinoma (HCC). Methods: Of 339 HCC patients who underwent curative hepatic resection, 218 were included for analysis. The LHL15 index (uptake ratio of the liver to that of the liver and heart at 15 min) was measured by 99m Tc-GSA (99m technetium-labelled galactosyl human serum albumin); remnant LHL15 was calculated as LHL15 × [1 − (resected liver weight − tumor volume)/whole liver volume without tumor]. Results: A total of 163 patients were classified as having no PHLF, whereas 17, 37, and 1 patient had PHLF grade A, B, and C, respectively. There were significant differences in indocyanine green R15, serum albumin, prothrombin time, Child-Pugh classification, LHL15 and remnant LHL15 between patients with grades B/C PHLF and patients with grade A or no PHLF. Only remnant LHL15 was identified as an independent risk factor for grades B/C PHLF (p = 0.023), with a cut-off value of 0.755. Conclusions: Remnant LHL15 was an independent risk factor for grades B/C PHLF. Patients with impaired remnant LHL15 value of <0.755 should be carefully monitored for PHLF.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Impaired Value of 99m Tc-GSA Scintigraphy as an Independent Risk Factor for Posthepatectomy Liver Failure in Patients with Hepatocellular Carcinoma

et al. 2018

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“…The process is helpful for surgeons to understand fully the specific details about key parts [26,27] . The occurrence of intraoperative incidents, such as biliary and vascular injuries, bleeding, and bile leakage, can be effectively prevented by designing different resection planes and optimizing surgical strategies [28,29] . Accurate anatomical evaluation and precise surgical planning contribute to selection of the best therapeutic methods for HAE [30,31] .…”

Section: Discussionmentioning

confidence: 99%

Application of 3D reconstruction for surgical treatment of hepatic alveolar echinococcosis

He¹,

Bai²,

Aji³

et al. 2015

WJG

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AIM:To evaluate the reliability and accuracy of threedimensional (3D) reconstruction for liver resection in patients with hepatic alveolar echinococcosis (HAE). METHODS:One-hundred and six consecutive patients with HAE underwent hepatectomy at our hospital between May 2011 and January 2015. Fifty-nine patients underwent preoperative 3D reconstruction and "virtual" 3D liver resection before surgery (Group A). Another 47 patients used conventional imaging methods for preoperative assessment (Group B). Outcomes of hepatectomy were compared between the two groups. RESULTS:There was no significant difference in preoperative data between the two groups. groups had good correlation with actual graft weight (Group A: r = 0.978; Group B: r = 0.960). There was a significant higher serum level of albumin in Group A (26.3 ± 5.9 vs 22.6 ± 4.3 g/L, P < 0.05). Other postoperative laboratory parameters (serum levels of aminotransferase and bilirubin; prothrombin time) and duration of postoperative hospital stay were similar. Sixteen complications occurred in Group A and 19 in Group B. All patients were followed for 3-46 (mean, 17.3) mo. There was no recurrence of lesions in Group A, but two recurrences in Group B. There were three deaths: two from cerebrovascular accident, and one from car accident. CONCLUSION:3D reconstruction provides comprehensive and precise anatomical information for the liver. It also improves the chance of success and reduces the risk of hepatectomy in HAE. Core tip: With the rapid development of digital medicine, three-dimensional (3D) reconstruction software has become a new tool in surgery, and it is a quantitative imaging analysis system that provides real-time interactive tools for presurgical evaluation and planning. We compared the clinical results of hepatectomy for hepatic alveolar echinococcosis based on 3D software with traditional assessment. We found that liver resection based on 3D reconstruction was more effective in the diagnosis and treatment of HAE than techniques without 3D reconstruction. Such 3D reconstruction software for preoperative evaluation and surgical planning could increase the chance of success of surgery and reduce operative risk.

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“…FLR calculations are rooted in either volumetric or functional algorithms, though the two approaches do not appear to be equally reliable. Although liver size and function correlate under normal conditions, this relationship devolves with cirrhosis, and therefore, functional tests have been shown to be more accurate predictors of operative outcome 53. Nonetheless, a volumetric FLR >20% in patients with healthy livers and >40% in the setting of chronic liver disease are established standards 54.…”

Section: Navigating Cirrhosis In Operative Planningmentioning

confidence: 99%

Hepatocellular carcinoma: early-stage management challenges

Erstad

Tanabe

2017

JHC

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Hepatocellular carcinoma (HCC) is a major cause of cancer death and is increasing in incidence. This review focuses on HCC surveillance and treatment of early-stage disease, which are essential to improving outcomes. Multiple societies have published HCC surveillance guidelines, but screening efforts have been limited by noncompliance and overall lack of testing for patients with undiagnosed chronic liver disease. Treatment of early-stage HCC has become increasingly complex due to expanding therapeutic options and better outcomes with established treatments. Surgical indications for HCC have broadened with improved preoperative liver testing, neoadjuvant therapy, portal vein embolization, and perioperative care. Advances in post-procedural monitoring have improved efficacies of transarterial chemoembolization and radiofrequency ablation, and novel therapies involving delivery of radiochemicals are being studied in small trials. Finally, advances in liver transplantation have allowed for expanded indications beyond Milan criteria with non-inferior outcomes. More clinical trials evaluating new therapies and multimodal regimens are necessary to help clinicians design better treatment algorithms and improve outcomes.

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Functional assessment versus conventional volumetric assessment in the prediction of operative outcomes after major hepatectomy

Cited by 72 publications

References 19 publications

Impaired Value of 99m Tc-GSA Scintigraphy as an Independent Risk Factor for Posthepatectomy Liver Failure in Patients with Hepatocellular Carcinoma

Impaired Value of 99m Tc-GSA Scintigraphy as an Independent Risk Factor for Posthepatectomy Liver Failure in Patients with Hepatocellular Carcinoma

Application of 3D reconstruction for surgical treatment of hepatic alveolar echinococcosis

Hepatocellular carcinoma: early-stage management challenges

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