Validation of liver function and prediction scoring system

Abstract

Introduction: Liver resection is performed for a variety of benign and malignant conditions. Despite advances in preoperative selection, surgical technique and perioperative management, posthepatectomy liver failure (PHLF) is still a leading cause of morbidity and mortality following liver resection. To avoid PHLF, we used various examination such as ICGR15, KICG, and estimated ICGR15 and KICG which are estimated by 99mTc-GSA SPECT, and functional liver volume estimated by 99mTc-GSA SPECT/MDCT fusion image, and used various prediction scoring system such as Makuuchi’s criteria, Prediction Score made by Hyogo college of medicine (PS), and Indocyanine green clearance of the future remnant liver (remKICG). The present study aimed to identify the risk factors for PHLF and validate these prediction formulas. Method: 329 patients who underwent hepatectomy without extrahepatic bile duct resection were retrospectively analyzed. Among 329 patients, major hepatectomy was performed in 79 patients (24%). Grade B and C PHLF based on ISGLS definition occurred in 11 patients (3.3%). Univariate and multivariate analyses were performed to identify the risk factors for PHLF. Result: The functional resection volume rate estimated by 99mTc-GSA SPECT/MDCT fusion image (%FRV), direct bilirubin and KICG were the risk factors according to multivariate analysis. Functional remKICG calculated by using %FRV and KICG which were obtained by multivariate analysis, had a sensitivity of 18.2%, a specificity of 100%, a positive prediction value of 100%, and a negative prediction value of 97.2%. Conclusion: %FRV, Direct bilirubin and KICG were the risk factor for PHLF. Functional remKICG was considered the most reliable prediction formula.