Predicting hepatic failure with a new diagnostic technique by preoperative liver scintigraphy and computed tomography: a pilot study in 123 patients undergoing liver resection

Abstract

BackgroundA novel index, total liver LU15, has been identified as a surrogate marker for liver function. We evaluated the ability of preoperative remnant liver LU15 values to predict postoperative hepatic failure.MethodsPreoperative risk factors for postoperative hepatic failure and remnant liver LU15 were evaluated in 123 patients undergoing liver resection for several diseases from September 1st, 2007 to December 1st, 2016. We calculated the remnant liver LU15 value from the total liver LU15 value and the functional remnant liver ratio. Risk factors for postoperative hepatic failure was determined by univariate and multivariate analysis.ResultsHepatic failure grade B/C developed postoperatively in six patients of seven patients within Makuuchi criteria / without criteria for remnant liver LU15. Operative time (p = 0.0242) and criteria for remnant liver LU15 (p = 0.0001) were prognostic factors for hepatic failure according to the univariate analysis. And criteria for remnant liver LU15 (p = 0.0009) was only prognostic factor by multivariate analysis.ConclusionBased on the findings form this pilot study, it appears that patients with a remnant liver LU15 value of 13 or less may have a high risk of postoperative hepatic failure.

The diagnostic value of 99m-Tc GSA scintigraphy for liver function and remnant liver volume in hepatic surgery: a retrospective observational cohort study in 27 patients

“…The indication of hepatectomy for liver metastasis was good function of future remnant liver and without extrahepatic lesions. And the PVE indication was less than 13.0 of remnant liver LU calculated by 99 m-Tc-GSA liver scintigrahy [ 6 ]. ALLPS procedure was performed with only the patients, who has insufficient future remnant liver volume and whom was planned surgical procedure of tri-sectionectomy and partial hepatectomy.…”

“…In addition, the distribution of 99mTc-GSA in the liver is not dependent on liver blood flow [ 5 ]. Our previous study has shown that a novel index, remnant liver LU15, has been identified as a surrogate marker for remnant liver function and preoperative remnant liver LU15 values might predict hepatic failure following a liver resection without biliary reconstruction [ 6 ].…”

Evaluation of patients who underwent percutaneous transhepatic portal vein embolisation by Tc-99m GSA scintigraphy

“…To date, the usefulness of Tc-99m galactosyl human serum albumin (GSA) scintigraphy for more accurate evaluation of underlying liver diseases, such as cirrhosis [4,5], during both the preoperative [2,3,6] and peri-PTPE period [7,8], have been reported. A variety of radionuclide parameters can be used for Tc-99m GSA scintigraphy, depending on the institute.…”

“…Residual liver uptake at 15 minutes (RLU15), which was reported by Koizumi et al ., is the cumulative residual liver accumulation rate of a GSA tracer 15 minutes after its injection, and it indicates residual liver function [9]. To safely perform hepatectomies, it has been reported that the RLU15 should theoretically [10] and clinically [2] be 13 or more. A co-author of the present manuscript has already reported the usefulness of using RLU15 to predict liver failure [2]; however, to date, there has been no evaluation of the effectiveness of PTPE using RLU15.…”

“…To safely perform hepatectomies, it has been reported that the RLU15 should theoretically [10] and clinically [2] be 13 or more. A co-author of the present manuscript has already reported the usefulness of using RLU15 to predict liver failure [2]; however, to date, there has been no evaluation of the effectiveness of PTPE using RLU15. We report herein a correlation between morphological residual liver volume (RLV) and RLU15 before and after PTPE in 20 patients, and also compare the rate of increase in RLV and RLU15 between two groups, diagnosed and evaluated as having pathological cirrhosis vs. non-cirrhosis, and post-chemotherapy vs. non-chemotherapy.…”