Affiliation:
1. Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, Tsu, Japan
Abstract
Background
Few studies have investigated the remnant hepatic functional reserve before hepatectomy by calculating the functional remnant liver rate (RLR) using three-dimensional computed tomography (3D-CT)/technetium-99m-diethylenetriamine-pentaacetic acid galactosyl human serum albumin (99mTc-GSA) single-photon emission CT (SPECT) fusion imaging. We aimed to preoperatively evaluate the predictive value of functional remnant liver rate (RLR) and indocyanine green (ICG) disappearance rate (KICG) in determining the occurrence of posthepatectomy liver failure (PHLF).
Summary of Background Data
The conventional method of volumetric rem-KICG calculated from remnant liver volume and the KICG is difficult to accurately reflect heterogenous remnant liver function.
Methods
In total, 106 patients who underwent major hepatectomy were retrospectively analysed. Of these, 24 (22.6%) developed clinically relevant PHLF grades B/C. We examined the ICG retention rate at 15 min (ICGR15) and KICG and constructed a 3D-CT/99mTc-GSA SPECT fusion image to calculate the volumetric RLR, functional RLR, volumetric rem-KICG, and functional rem-KICG.
Results
The multivariate analysis showed functional rem-KICG as the strongest independent risk factor for PHLF grade B/C. The functional-to-volumetric RLR ratios in the patients with portal vein obstruction and/or tumor volume of ≥500 mL was significantly higher. The volumetric rem-KICG determined that hepatectomy was unsafe in 7 patients, whereas the functional rem-KICG determined that it was unsafe in 3 patients.
Conclusions
Functional rem-KICG was more reliable than volumetric rem-KICG in predicting clinically relevant PHLF grade B/C, as the resected side’s hepatic status highly influenced the function of the remnant liver. This finding could lead to a wider application of this technique.
Publisher
International College of Surgeons