Abstract
Background: ALPPS induces a rapid and extensive increase in liver volume. The functional quality of this hypertrophic response has been questioned since ALPPS is associated with a substantial incidence of liver failure and increased perioperative mortality. This multicenter study aimed to evaluate functional liver regeneration in contrast to volumetric regeneration using 99mTc hepatobiliary scintigraphy (HBS) in ALPPS. Methods: Atients who underwent ALPPS and HBS in four centers were included. HBS data were analyzed centrally by a single Nuclear Medicine physician according to established protocols. Increase in liver function after stage 1 ALPPS was compared to the increase in liver volume. In addition, the impact of liver function and volume on postoperative outcomes was analyzed including liver failure, morbidity, and mortality. Results: In 34 patients, future liver remnant volume increased by 76% (median, range 7-287) over 7 (median, range 3-31) days after stage one, while function increased by 41% (median, range 40-243%) over 6 days (median, range 5-17). After stage 2 ALPPS, liver failure occurred in 4/34 (12%) patients, severe complications in 17/34 (50%), and mortality was 12% (4/34). Conclusion: In ALPPS, volumetry overestimates liver function and may be responsible for the high rate of liver failure. Quantitative liver function tests are indispensable to avoid post hepatectomy liver failure.
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