Hepatobiliary scintigraphy combined with SPECT/CT in predicting liver failure before major hepatectomy: preliminary results of the HIBA-index at a single center

Abstract

Introduction: Hepatobiliary scintigraphy (HBS) is able to estimate future liver remnant function (FLR-F) and may be useful to predict post-hepatectomy liver failure (PHLF) before major hepatectomy. Existing cut-off values for PHLF (FLR-F < 2.69%/min/m2) were previously set using only planar acquisitions but not combined with single photon emission computed tomography (SPECT/CT). A new index, the so-called Hospital Italiano De Buenos Aires index (HIBA-i), has been recently used to measure sectorial liver function in two-stage hepatectomy setting. Method: All consecutive patients submitted to major hepatectomy between November 2016 and November 2017 at Sant'Orsola-Malpighi Hospital (Bologna, Italy), were analyzed. Patients were resected according to their preoperative volumetry. Data regarding preoperative HBS were retrospectively reviewed. FLR-F and HIBA-i were calculated as previously described. PHLF was defined according to the International Study Group of Liver Surgery criteria. Results: Twenty-seven patients were submitted to major hepatectomy (13 right hepatectomies, 8 left hepatectomies, 5 right trisectionectomies, 1 left trisectionectomy). PHLF (grade A/B/C) was observed in 9 out of 27 patients (33.3%). The HIBA-i differed significantly (p=0.002) between patients with (14.37%, IQR 8.64-16.14) and without PHLF (24.31%, IQR 15.74-39.53). Eight of 16 patients with a preoperative FLR-F < 2.69 %/min/m2 did not experienced PHLF. FLR volumes between the two groups did not show any statistical significance. Conclusions: The HIBA-i seems a promising tool able to estimate residual liver function. Prospective clinical trial are warranted to define more precise cut-offs of FLR-F when SPECT/CT is associated.