Nuclear imaging methods for the prediction of postoperative morbidity and mortality in patients undergoing localized, liver-directed treatments: a systematic review

Caroline Espersen,Louise Stenholt,Trine Borup Andersen,Peter Nørgaard Larsen,Lise Borgwardt,Lars Jelstrup Petersen

doi:10.1186/s13550-020-00687-1

Caroline Espersen, Louise Stenholt + Show 4 more

Open Access

https://doi.org/10.1186/s13550-020-00687-1

Copy DOI

Abstract

BackgroundSeveral nuclear imaging methods may predict postoperative liver function and outcome, but none has achieved recommendations in clinical guidelines. The purpose of this systematic review was to summarize the existing knowledge on this topic.MethodsMEDLINE and Web of Science were searched for studies investigating nuclear medicine imaging methods for the prediction of postoperative liver function in patients undergoing localized, liver-directed treatments. The postoperative endpoints were clinical outcome (morbidity and mortality) as well as measures of postoperative liver function, e.g., liver function assessed by biochemical tests or nuclear imaging.ResultsA total of 1352 references were identified, of which 82 fulfilled the eligibility criteria and were included in the review. Most studies (n = 63) were retrospective studies. The vast majority of studies assessed [99mTc]Tc-galactosyl serum albumin (GSA) (n = 57) and [99mTc]Tc-mebrofenin (n = 19). Liver resection was entirely or partly major (involved at least three segments) in 78 reports. There were notable variations in the research methodology, e.g., image acquisition, imaging variables, and endpoints. Thirty-seven studies reported on postoperative mortality, of which most reported descriptive data at the patient level. Of the four reports that performed multivariate analyses, two showed significant predictive results of isotope-based preoperative tests. Fifty-two papers presented data on postoperative liver failure. Multivariate predictive analyses were performed in eighteen trials, of which fifteen showed the significant value of nuclear medicine tests.ConclusionThere is sparse evidence supporting the significant value of nuclear medicine imaging methods in predicting postoperative mortality. In contrast, a notable number of trials showed a significant prediction of liver failure in multivariate analyses. The research methodology was heterogeneous and exploratory in most trials. Documentation of nuclear medicine tests in this setting awaits the results of properly designed, prospective trials with the standardization of both the nuclear medicine test and endpoints.

Highlights

Several nuclear imaging methods may predict postoperative liver function and outcome, but none has achieved recommendations in clinical guidelines
Based on the title and abstract screening, 933 studies were excluded, leaving 186 studies for full-text screening, of which 82 eligible studies were included in the systematic review
Study demographics The majority of the included studies investigated the use of [99mTc]Tc-(Human) galactosyl serum albumin (GSA) (57 studies), and the majority of those trials originated from Japan (56 studies) (Table 1)

Summary

Introduction

Several nuclear imaging methods may predict postoperative liver function and outcome, but none has achieved recommendations in clinical guidelines. Any procedure with the purpose of removing large amounts of diseased liver tissue should include a pre-procedural risk assessment by estimating the future liver remnant (FLR) function to avoid post-procedure LF, mortality, or other liver-related complications. Both computed tomography (CT) and biochemical liver function tests have been employed in the preoperative assessment by measuring the volume of the FLR and the global liver function, respectively [8]. Estimating the function of the FLR directly may be more reliable in predicting the real postoperative remnant liver function rather than estimating the volume or global liver function [8, 10, 11]

Methods

Results

Discussion

Conclusion