Predicting hepatic failure with a new diagnostic technique by preoperative liver scintigraphy and computed tomography: a pilot study in 123 patients undergoing liver resection

Naokazu Chiba,Koichi Tomita,Kosuke Hikita,Go Oshima,Motohide Shimazu,Shigeyuki Kawachi,Toru Sano,Kiminori Takano,Takahiro Gunji,Kiyoshi Koizumi,Masaaki Okihara,Yuta Abe,Yosuke Ozawa

doi:10.1186/s13037-017-0143-z

Naokazu Chiba, Koichi Tomita + Show 11 more

Open Access

https://doi.org/10.1186/s13037-017-0143-z

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Abstract

BackgroundA novel index, total liver LU15, has been identified as a surrogate marker for liver function. We evaluated the ability of preoperative remnant liver LU15 values to predict postoperative hepatic failure.MethodsPreoperative risk factors for postoperative hepatic failure and remnant liver LU15 were evaluated in 123 patients undergoing liver resection for several diseases from September 1st, 2007 to December 1st, 2016. We calculated the remnant liver LU15 value from the total liver LU15 value and the functional remnant liver ratio. Risk factors for postoperative hepatic failure was determined by univariate and multivariate analysis.ResultsHepatic failure grade B/C developed postoperatively in six patients of seven patients within Makuuchi criteria / without criteria for remnant liver LU15. Operative time (p = 0.0242) and criteria for remnant liver LU15 (p = 0.0001) were prognostic factors for hepatic failure according to the univariate analysis. And criteria for remnant liver LU15 (p = 0.0009) was only prognostic factor by multivariate analysis.ConclusionBased on the findings form this pilot study, it appears that patients with a remnant liver LU15 value of 13 or less may have a high risk of postoperative hepatic failure.

Highlights

A novel index, total liver LU15, has been identified as a surrogate marker for liver function
When a hepatic resection involves more than two sections, evaluation of future functional reserve by using 99mTc-GSA and computed tomography (CT) combined fusion images is currently supposed to be more accurate than a combined estimation using an indocyanine green (ICG) retention test and CT [10]
A retrospective study was performed to determine whether the remnant liver LU15 value could enable a final decision regarding a hepatectomy in order to avoid postoperative hepatic failure

Summary

Introduction

A novel index, total liver LU15, has been identified as a surrogate marker for liver function. When a hepatic resection involves more than two sections, evaluation of future functional reserve by using 99mTc-GSA and computed tomography (CT) combined fusion images is currently supposed to be more accurate than a combined estimation using an indocyanine green (ICG) retention test and CT [10]. Remnant liver LU15, which was considered the remnant hepatic functional reserve, was estimated using 99mTc-GSA single-photon emission computed tomograpic (SPECT) scintigraphy and CT fusion images. The functional reserve of the future liver remnant was estimated before surgery by using fusion images obtained from contrast-enhanced CT and 99mTc-GSA SPECT, and was used to predict liver failure after a hepatic resection. A retrospective study was performed to determine whether the remnant liver LU15 value could enable a final decision regarding a hepatectomy in order to avoid postoperative hepatic failure

Methods

Results

Conclusion