Presurgical functional liver capacitiy assessment before major liver resections: a comparison of 99mTc-mebrofenin hepatobiliary scintigraphy and LiMAx to predict posthepatectomy liver failure

Abstract

Introduction: Posthepatectomy liver failure (PHLF) is a severe problem after major liver resections and is linked with higher morbidity and mortality. Our goal must be to implement a presurgical routine to measure the current liver function and to calculate future remnant liver function for further individual therapeutic decisions. This study investigates postoperative outcome by comparing 99mTc-mebrofenin hepatobiliary scintigraphy and maximum liver function capacity test (LIMAx). Methods: We performed a full presurgical liver capacity assessment in 13 patients before major liver resections because of hepatobiliary malignancies. We compared the results of the hepatobiliary scintigraphy to the LIMAx-Test to detect posthepatectomy liver failure (50-50 criteria, peak-bili 7, ISGLS-criteria) and postoperative complications (Dindo-Clavien Classification, CCI). Results: 9 patients showed critical levels in the 99mTc-mebrofenin hepatobiliary scintigraphy (< 2.7 %/min/m2) and 4 patients in the LiMAx-Test (< 100 μg/h/kg). PHLF appeared in 3 patients according to the ISGLS-criteria (1 ISGLS-A, 2 ISGLS-B). In total 4 patients met the requirements of the Peak-Bili-7 criteria including the above-mentioned 3 patients. Two of the 4 patients were not recognized as critical by preoperative functional liver assessment, neither by scintigraphy nor by LiMAx. The Evaluation of postoperative complications based on the Dindo-Clavien Classification (IIIb or higher) occurred in 3 patients. The 90-day mortality was 0%. Conclusion: Both methods, 99mTc-mebrofenin scintigraphy and LiMAx, can be used to improve the prediction of posthepatectomy liver failure. For better accuracy and reliability further investigations are necessary.