Measurement of liver function using hepatobiliary scintigraphy improves risk assessment in patients undergoing major liver resection

Kasia P Cieslak, Roelof J Bennink, Wilmar de Graaf, Krijn P van Lienden, Marc G Besselink, Olivier R C Busch, Dirk J Gouma, Thomas M van Gulik, Kasia P Cieslak, Roelof J Bennink, Wilmar de Graaf, Krijn P van Lienden, Marc G Besselink, Olivier R C Busch, Dirk J Gouma, Thomas M van Gulik

Abstract

Background: (99m)Tc-mebrofenin-hepatobiliary-scintigraphy (HBS) enables measurement of future remnant liver (FRL)-function and was implemented in our preoperative routine after calculation of the cut-off value for prediction of postoperative liver failure (LF). This study evaluates our results since the implementation of HBS. Additionally, CT-volumetric methods of FRL-assessment, standardized liver volumetry and FRL/body-weight ratio (FRL-BWR), were evaluated.

Methods: 163 patients who underwent major liver resection were included. Insufficient FRL-volume and/or FRL-function <2.7%/min/m(2) were indications for portal vein embolization (PVE). Non-PVE patients were compared with a historical cohort (n = 55). Primary endpoints were postoperative LF and LF related mortality. Secondary endpoint was preoperative identification of patients at risk for LF using the CT-volumetric methods.

Results: 29/163 patients underwent PVE; 8/29 patients because of insufficient FRL-function despite sufficient FRL-volume. According to FRL-BWR and standardized liver volumetry, 16/29 and 11/29 patients, respectively, would not have undergone PVE. LF and LF related mortality were significantly reduced compared to the historical cohort. HBS appeared superior in the identification of patients with increased surgical risk compared to the CT-volumetric methods.

Discussion: Implementation of HBS in the preoperative work-up led to a function oriented use of PVE and was associated with a significant decrease in postoperative LF and LF related mortality.

Copyright © 2016 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.

Figures

Figure 1
Figure 1
Low dose CT and 99mTc-mebrofenin SPECT before (a, b) and 3 weeks after (c, d) right sided PVE in a patient with a primary liver tumor (tumor not visible on low dose CT, white line indicates the FRL). Both volume (c) and function (d) of left liver segments show increase after PVE. There is a decrease in function in the right sided embolized liver lobes (d)

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