Measuring future liver remnant function prior to hepatectomy may guide the indication for portal vein occlusion and avoid posthepatectomy liver failure: a prospective interventional study

Chapelle, T.; Beeck, Bart Op de; Roeyen, Geert; Bracke, B.; Hartman, V.; Greef, Kathleen De; Huyghe, Ivan; Zijden, Thijs van der; Morrison, Stuart; Francque, Sven; Ysebaert, Dirk

doi:10.1016/j.hpb.2016.11.005

Cited by 23 publications

(13 citation statements)

References 24 publications

(32 reference statements)

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“…Five studies reported historical comparisons on the outcome rate of LF and mortality in the period before and after implementation of nuclear imaging as a preoperative examination in patients undergoing liver surgery [ 16 , 20 , 25 , 56 , 58 ]. Overall, the historical comparisons involving [ 99m Tc]Tc-mebrofenin found that implementation of nuclear imaging in the preoperative assessment resulted in lower mortality and liver failure rates [ 16 , 20 , 25 ], whereas the historical comparisons on the use of [ 99m Tc]Tc-GSA did not result in a significant decrease in the number of liver failure cases in the period after implementation of [ 99m Tc]Tc-GSA liver scintigraphy [ 56 , 58 ].…”

Section: Resultsmentioning

confidence: 99%

“…Five studies reported historical comparisons on the outcome rate of LF and mortality in the period before and [16,20,25], whereas the historical comparisons on the use of [ 99m Tc]Tc-GSA did not result in a significant decrease in the number of liver failure cases in the period after implementation of [ 99m Tc]Tc-GSA liver scintigraphy [56,58].…”

Section: Historical Comparisonsmentioning

confidence: 99%

“…Thus, there were only a few clinical utility studies. However, the studies applying a predetermined cut-off value in a prospective setting validated the cut-off and proved that the cut-off value was able to safely determine which patients could undergo hepatic resection with resulting low mortality and LF rates [20,63] Hepatobiliary scintigraphy has shown a promising value in the preoperative assessment of patients undergoing liver resection, and it has been utilized by several nuclear medicine departments worldwide over the last decade. Still, there are no widely accepted international guidelines that recommend the use of nuclear medicine imaging to determine the resectability of patients prior to undergoing a procedure with the purpose of removing diseased liver tissue.…”

Section: Nr (Nr)mentioning

confidence: 99%

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Nuclear imaging methods for the prediction of postoperative morbidity and mortality in patients undergoing localized, liver-directed treatments: a systematic review

et al. 2020

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Background: Several nuclear imaging methods may predict postoperative liver function and outcome, but none has achieved recommendations in clinical guidelines. The purpose of this systematic review was to summarize the existing knowledge on this topic. Methods: MEDLINE and Web of Science were searched for studies investigating nuclear medicine imaging methods for the prediction of postoperative liver function in patients undergoing localized, liver-directed treatments. The postoperative endpoints were clinical outcome (morbidity and mortality) as well as measures of postoperative liver function, e.g., liver function assessed by biochemical tests or nuclear imaging. Results: A total of 1352 references were identified, of which 82 fulfilled the eligibility criteria and were included in the review. Most studies (n = 63) were retrospective studies. The vast majority of studies assessed [ 99m Tc]Tcgalactosyl serum albumin (GSA) (n = 57) and [ 99m Tc]Tc-mebrofenin (n = 19). Liver resection was entirely or partly major (involved at least three segments) in 78 reports. There were notable variations in the research methodology, e.g., image acquisition, imaging variables, and endpoints. Thirty-seven studies reported on postoperative mortality, of which most reported descriptive data at the patient level. Of the four reports that performed multivariate analyses, two showed significant predictive results of isotope-based preoperative tests. Fifty-two papers presented data on postoperative liver failure. Multivariate predictive analyses were performed in eighteen trials, of which fifteen showed the significant value of nuclear medicine tests. Conclusion: There is sparse evidence supporting the significant value of nuclear medicine imaging methods in predicting postoperative mortality. In contrast, a notable number of trials showed a significant prediction of liver failure in multivariate analyses. The research methodology was heterogeneous and exploratory in most trials. Documentation of nuclear medicine tests in this setting awaits the results of properly designed, prospective trials with the standardization of both the nuclear medicine test and endpoints.

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Section: Resultsmentioning

confidence: 99%

Section: Historical Comparisonsmentioning

confidence: 99%

Section: Nr (Nr)mentioning

confidence: 99%

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Nuclear imaging methods for the prediction of postoperative morbidity and mortality in patients undergoing localized, liver-directed treatments: a systematic review

et al. 2020

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“…A prospective interventional study investigated management strategy to avoid PHLF in 100 patients. [ 41 ] eFRL-F cutoff of 2.3%/min/m 2 as described by Chapelle et al . [ 35 ] was used to decide management.…”

Section: Resultsmentioning

confidence: 99%

Liver functional volumetry by Tc-99m mebrofenin hepatobiliary scintigraphy before major liver resection: A game changer

et al. 2018

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Future remnant liver function (FRL-F) estimation is important before major liver resection to avoid posthepatectomy liver failure (PHLF). Conventionally, it is estimated by global dynamic liver function tests which assume homogeneous liver function and unable to calculate regional function. Computed tomography is another method to estimate FRL volume but assumes that volume is equivalent to function. Hence, a global and regional non-invasive liver function test is desirable. Studies were identified by MEDLINE, PubMed, and Google Scholar for articles from January 1990 to December 2017 using the following keywords “Mebrofenin, hepatobiliary scintigraphy (HBS), FRL-F, PHLF, portal vein embolization (PVE).” HBS with technetium-99 m galactosyl human serum albumin (Tc-99m GSA) and Tc-99m Mebrofenin is a known test for functional liver assessment. Restricted availability of Tc-99m GSA only in Japan is a main drawback for its global acceptance. However, Tc-99m Mebrofenin is routinely available to the rest of the world. A unique protocol for FRL-F estimation by Tc-99m Mebrofenin is described in detail in this review. Tc-99m Mebrofenin HBS has shown a strong correlation to 15 min indocyanine green clearance. HBS has been reported better in predicting the risk of PHLF with a 2.69%/min/m2 cutoff of FRL-F. Tc-99m Mebrofenin HBS has been found better in stratification of PVE before major liver surgery as well. We concluded, Tc-99m Mebrofenin HBS was unique in calculating global and regional liver function and takes nonuniformity and underlying pathology in the account. Moreover, a single cutoff might fit in all for PHLF risk assessment and PVE stratification.

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“…91,92 One of the strategies used to prevent this syndrome is portal vein embolization 4 to 6 weeks prior to hepatectomy, which gives time for the perfused segments of the liver to undergo hypertrophy, effectively increasing the functional liver remnant at the time of hepatectomy. 93,94 Naturally, a prerequisite for this approach is a capable interventional radiology (IR) department working in coordination with the hepatobiliary surgeon. Another option to prevent this has been explored in experimental settings, where a portocaval shunt at the time of resection decreased sinusoidal edema and improved survival.…”

Section: Surgical Portosystemic Shunts In Liver Resectionsmentioning

confidence: 99%

Surgical Portosystemic Shunts: History, Evolution, and Current Applications

López‐Verdugo

Sánchez-García

Gagnon

et al. 2020

Digestive Disease Interventions

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AbstractMechanical obstruction, thrombus, intrinsic liver disease causing fibrosis or cirrhosis, or an outflow obstruction at the level of the sinusoids or hepatic venous obstruction can cause an increase in pressure or resistance, or both, leading to portal hypertension (PH). Portosystemic shunts (PSS) are usually performed to relieve the congestion that inevitably occurs in the setting of PH. Since their introduction, surgical PSS were often the treatment of choice to prevent recurrent bleeding in patients with clinically significant PH. Development of novel pharmacological therapies, continuous improvement of endoscopic approaches, the introduction of transjugular intrahepatic portosystemic shunt, and advancements in transplantation has provided an evolution in the approach for PH and has precipitated the steady decrease in the proportion of patients needing surgical shunts. Despite this, PSS remain important tools in the surgeon's armamentarium, as they are often employed in the pediatric population with extrahepatic portal vein obstruction and are frequently being used for portal inflow modulation to achieve better portal hemodynamics in resections and transplantation. This has become of great relevance to decrease the risk of small-for-size syndrome and portal hyperperfusion in liver transplantation, and to decrease the risk of posthepatectomy liver dysfunction after major resections in hepatobiliary surgery.

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Measuring future liver remnant function prior to hepatectomy may guide the indication for portal vein occlusion and avoid posthepatectomy liver failure: a prospective interventional study

Abstract: A predefined cutoff for preoperatively calculated eFLRF can be used as a tool for selecting patients prior to hepatectomy, with or without PVO, thus avoiding PHLF and PHLF-related mortality.

Cited by 23 publications

References 24 publications

Nuclear imaging methods for the prediction of postoperative morbidity and mortality in patients undergoing localized, liver-directed treatments: a systematic review

Nuclear imaging methods for the prediction of postoperative morbidity and mortality in patients undergoing localized, liver-directed treatments: a systematic review

Liver functional volumetry by Tc-99m mebrofenin hepatobiliary scintigraphy before major liver resection: A game changer

Surgical Portosystemic Shunts: History, Evolution, and Current Applications

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