Initial evaluation of the protocol for the liver remnant after major hepatectomies with liver volumetry using ct and funtionality with single photon emission computed tomography-hepatobiliary scintigraphy (mtc99-mebrofenin)

Abstract

Background: Hepatobiliary scintigraphy with mTc99-mebrofenin (HBS) is being used as a quantitative method to evaluate liver function.Single photon emission computed tomography (SPECT) has allowed a more accurate measurement of segmental liver function . Material and Methods: Since August 2017 a CT volumetry and SPECT-HBS is performed in mayor liver resection excluding left hepatectomy with non-compromised future liver remnant (FLR).The volumetric cut-off of the FLR is 35% in non-compromised and 40% in compromised liver. The HBS-SPECT will assess FLR function with FLR %, De Graaf index (> 2.7% / min / m2) and the HIBA-Index (≥15%). FLR weight /patient weight is obtained. Morbidity is classified by Dindo-Clavien. Liver failure is measured by IGSLS and 50/50. Results: A total of 20 HBS were performed, 2 patients were excluded preoperatively (progression). Cholangiocarcinoma was the most common diagnosis ,50%,followed by colorectal liver metastases 44.4%. 55.6% were female with a median age of 68 years (35-83). 83.3% were preoperatively considered as compromised liver, only 5.6% of them were cirrhotic. 16.6% had right portal vein embolization. In 11.1% an ALPPS procedure was performed. The median liver remnant weight ,liver remnant % and liver remnant weight/patient weight was 620gr (336.1-1270),40.1%(24.3-75) and 0.92(0.46-1.99).The median FLR % , De Graaf index, and HIBA Index were 51% (29-89), 2.2 %/min/m2 (0.4-8.6) and 16%(8-30%). 61.1% had a functional FLR below De Graaf index and 25% below the HIBA-Index. 44.4% of all patients presented postoperative morbidity (11.1 % were ≥IIIA). 2 patients developed postresection liver failure both of them had a De Graff index below the cut-off but none have a HIBA-index below the cut-off; however, both presented portal thrombosis. Conclusion: SPECT-HBS to calculate FLR function (De Graaf /HIBA index) could be a valuable technique to estimate the risk of postoperative liver insufficiency complementary to CT volumetry, but more experience is still needed.