Major Hepatectomy in a Child with Extremely Low Future Liver Remnant Without Posthepatectomy Liver Failure

Abstract

Introduction: The threshold value of future liver remnant volume (FLR-V)-25% for healthy liver is a standard in adults liver surgery. This method was translated in pediatric population without correlation to age, weight and liver function in children. Assessment of future liver remnant function (FLR-F) by means of hepatobiliary scintigraphy (HBS) is supposed to be more precise tool in children undergoing extended liver resection. An experience of major hepatectomy (MH), accomplished despite the extremely low FLR-V in a 27mo boy with advanced hepatoblastoma (HB) is discussed below. Method: Since June 2017 in our Center investigation of both: FLR-V (CT-volumetry) and FLR-F by means of 99mTc-Mebrofenin HBS before liver resections became a standard practice. The cut-off value of FLR-F is 2.7%/min/m2. The decision about MH was made on the basis of received values. Results: According to preoperative CT-volumetry, in patient with HB involving segments 4,7,8,1 (POSTTEXT III) the FLR-V in S2,3 came to 16.5%. 99mTc-Mebrofenin HBS showed the FLR-F 3.95%/min/m2. Taking into consideration the sufficient FLR-F, the extended right hepatectomy and caudate lobectomy was implemented instead of two-staged hepatectomy (TSH). The postoperative course was uneventful with no signs of posthepatectomy liver failure (PHLF). Patient was discharged on POD 12 and started adjuvant chemotherapy on time. The repeat FLR-F investigation on POD 30 came to 15.8%/min/m2. Conclusion: The presented case depicts that FLR-F is more precise than FLR-V in prediction of PHLF. 99mTc-Mebrofenin HBS is a sensitive method in selection of pediatric patients for safe MH instead of TSH or liver transplantation.