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Primavesi F, Maglione M, Cipriani F, Denecke T, Oberkofler CE, Starlinger P, Dasari BVM, Heil J, Sgarbura O, Søreide K, Diaz-Nieto R, Fondevila C, Frampton AE, Geisel D, Henninger B, Hessheimer AJ, Lesurtel M, Mole D, Öllinger R, Olthof P, Reiberger T, Schnitzbauer AA, Schwarz C, Sparrelid E, Stockmann M, Truant S, Aldrighetti L, Braunwarth E, D’Hondt M, DeOliveira ML, Erdmann J, Fuks D, Gruenberger T, Kaczirek K, Malik H, Öfner D, Rahbari NN, Göbel G, Siriwardena AK, Stättner S. E-AHPBA-ESSO-ESSR Innsbruck consensus guidelines for preoperative liver function assessment before hepatectomy. Br J Surg 2023; 110:1331-1347. [PMID: 37572099 PMCID: PMC10480040 DOI: 10.1093/bjs/znad233] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/09/2023] [Accepted: 07/04/2023] [Indexed: 08/14/2023]
Abstract
BACKGROUND Posthepatectomy liver failure (PHLF) contributes significantly to morbidity and mortality after liver surgery. Standardized assessment of preoperative liver function is crucial to identify patients at risk. These European consensus guidelines provide guidance for preoperative patient assessment. METHODS A modified Delphi approach was used to achieve consensus. The expert panel consisted of hepatobiliary surgeons, radiologists, nuclear medicine specialists, and hepatologists. The guideline process was supervised by a methodologist and reviewed by a patient representative. A systematic literature search was performed in PubMed/MEDLINE, the Cochrane library, and the WHO International Clinical Trials Registry. Evidence assessment and statement development followed Scottish Intercollegiate Guidelines Network methodology. RESULTS Based on 271 publications covering 4 key areas, 21 statements (at least 85 per cent agreement) were produced (median level of evidence 2- to 2+). Only a few systematic reviews (2++) and one RCT (1+) were identified. Preoperative liver function assessment should be considered before complex resections, and in patients with suspected or known underlying liver disease, or chemotherapy-associated or drug-induced liver injury. Clinical assessment and blood-based scores reflecting liver function or portal hypertension (for example albumin/bilirubin, platelet count) aid in identifying risk of PHLF. Volumetry of the future liver remnant represents the foundation for assessment, and can be combined with indocyanine green clearance or LiMAx® according to local expertise and availability. Functional MRI and liver scintigraphy are alternatives, combining FLR volume and function in one examination. CONCLUSION These guidelines reflect established methods to assess preoperative liver function and PHLF risk, and have uncovered evidence gaps of interest for future research.
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Affiliation(s)
- Florian Primavesi
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
- Department of General, Visceral and Vascular Surgery, Centre for Hepatobiliary Surgery, Vöcklabruck, Austria
| | - Manuel Maglione
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Federica Cipriani
- Hepatobiliary Surgery Division, San Raffaele Scientific Institute, Milan, Italy
| | - Timm Denecke
- Department of Diagnostic and Interventional Radiology, University Medical Centre Leipzig, Leipzig, Germany
| | - Christian E Oberkofler
- Swiss Hepatopancreatobiliary Transplant Centre, Department of Surgery, University Hospital Zürich, Zürich, Switzerland
- Vivévis AG—Visceral, Tumour and Robotic Surgery, Clinic Hirslanden Zürich, Zürich, Switzerland
| | - Patrick Starlinger
- Department of Surgery, Division of Hepatobiliary and Pancreatic Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Centre of Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Bobby V M Dasari
- Department of Hepatobiliary–pancreatic and Liver Transplantation Surgery, University of Birmingham, Birmingham, UK
| | - Jan Heil
- Department of General, Visceral, Transplant and Thoracic Surgery, Goethe University Frankfurt, University Hospital, Frankfurt, Germany
| | - Olivia Sgarbura
- Department of Surgical Oncology, Cancer Institute of Montpellier, University of Montpellier, Montpellier, France
- IRCM, Institut de Recherche en Cancérologie de Montpellier, INSERM U1194, Université de Montpellier, Institut Régional du Cancer de Montpellier, Montpellier, France
| | - Kjetil Søreide
- Department of Gastrointestinal Surgery, Hepatopancreatobiliary Unit, Stavanger University Hospital, Stavanger, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Rafael Diaz-Nieto
- Liver Surgery Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Constantino Fondevila
- General and Digestive Surgery Service, Hospital Universitario La Paz, IdiPAZ, CIBERehd, Madrid, Spain
| | - Adam E Frampton
- Hepatopancreatobiliary Surgical Unit, Royal Surrey NHS Foundation Trust, Guildford, UK
- Section of Oncology, Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
| | - Dominik Geisel
- Department of Radiology, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Benjamin Henninger
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Amelia J Hessheimer
- General and Digestive Surgery Service, Hospital Universitario La Paz, IdiPAZ, CIBERehd, Madrid, Spain
| | - Mickaël Lesurtel
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris Cité, Clichy, France
| | - Damian Mole
- Hepatopancreatobiliary Surgery Unit, Department of Clinical Surgery, University of Edinburgh, Edinburgh, UK
| | - Robert Öllinger
- Department of Surgery, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Pim Olthof
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
- Department of Surgery, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, the Netherlands
| | - Thomas Reiberger
- Division of Gastroenterology and Hepatology, Department of Medicine III and CD-Lab for Portal Hypertension and Liver Fibrosis, Medical University of Vienna, Vienna, Austria
| | - Andreas A Schnitzbauer
- Department of General, Visceral, Transplant and Thoracic Surgery, Goethe University Frankfurt, University Hospital, Frankfurt, Germany
| | - Christoph Schwarz
- Department of General Surgery, Division of Visceral Surgery, Medical University Vienna, Vienna, Austria
| | - Ernesto Sparrelid
- Department of Clinical Science, Intervention and Technology, Division of Surgery and Oncology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Martin Stockmann
- Department of Surgery, Charité–Universitätsmedizin Berlin, Berlin, Germany
- Department of General, Visceral and Vascular Surgery, Evangelisches Krankenhaus Paul Gerhardt Stift, Lutherstadt Wittenberg, Germany
| | - Stéphanie Truant
- Department of Digestive Surgery and Transplantation, CHU Lille, Lille University, Lille, France
- CANTHER Laboratory ‘Cancer Heterogeneity, Plasticity and Resistance to Therapies’ UMR-S1277, Team ‘Mucins, Cancer and Drug Resistance’, Lille, France
| | - Luca Aldrighetti
- Hepatobiliary Surgery Division, San Raffaele Scientific Institute, Milan, Italy
| | - Eva Braunwarth
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Mathieu D’Hondt
- Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital Kortrijk, Kortrijk, Belgium
| | - Michelle L DeOliveira
- Swiss Hepatopancreatobiliary Transplant Centre, Department of Surgery, University Hospital Zürich, Zürich, Switzerland
| | - Joris Erdmann
- Department of Surgery, Amsterdam UMC, Cancer Centre Amsterdam, the Netherlands
| | - David Fuks
- Department of Digestive, Hepatobiliary and Endocrine Surgery, Assistance Publique-Hôpitaux de Paris Centre Hopital Cochin, Paris, France
| | - Thomas Gruenberger
- Department of Surgery, Clinic Favoriten, Hepatopancreatobiliary Centre, Health Network Vienna and Sigmund Freud Private University, Vienna, Austria
| | - Klaus Kaczirek
- Department of General Surgery, Division of Visceral Surgery, Medical University Vienna, Vienna, Austria
| | - Hassan Malik
- Liver Surgery Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Dietmar Öfner
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Nuh N Rahbari
- Department of Surgery, University Hospital Mannheim, University of Heidelberg, Medical Faculty Mannheim, Mannheim, Germany
| | - Georg Göbel
- Department of Medical Statistics, Informatics, and Health Economics, Medical University of Innsbruck, Innsbruck, Austria
| | - Ajith K Siriwardena
- Regional Hepato-Pancreato-Biliary Unit, Manchester Royal Infirmary, Manchester, UK
| | - Stefan Stättner
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
- Department of General, Visceral and Vascular Surgery, Centre for Hepatobiliary Surgery, Vöcklabruck, Austria
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Marino R, Ratti F, Della Corte A, Santangelo D, Clocchiatti L, Canevari C, Magnani P, Pedica F, Casadei-Gardini A, De Cobelli F, Aldrighetti L. Comparing Liver Venous Deprivation and Portal Vein Embolization for Perihilar Cholangiocarcinoma: Is It Time to Shift the Focus to Hepatic Functional Reserve Rather than Hypertrophy? Cancers (Basel) 2023; 15:4363. [PMID: 37686638 PMCID: PMC10486473 DOI: 10.3390/cancers15174363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 08/28/2023] [Accepted: 08/30/2023] [Indexed: 09/10/2023] Open
Abstract
Purpose: Among liver hypertrophy technics, liver venous deprivation (LVD) has been recently introduced as an effective procedure to combine simultaneous portal inflow and hepatic outflow abrogation, raising growing clinical interest. The aim of this study is to investigate the role of LVD for preoperative optimization of future liver remnant (FLR) in perihilar cholangiocarcinoma (PHC), especially when compared with portal vein embolization (PVE). Methods: Between January 2013 and July 2022, all patients diagnosed with PHC and scheduled for preoperative optimization of FTR, through radiological hypertrophy techniques, prior to liver resection, were included. FTR volumetric assessment was evaluated at two distinct timepoints to track the progression of both early (T1, 10 days post-procedural) and late (T2, 21 days post-procedural) efficacy indicators. Post-procedural outcomes, including functional and volumetric analyses, were compared between the LVD and the PVE cohorts. Results: A total of 12 patients underwent LVD while 19 underwent PVE. No significant differences in either post-procedural or post-operative complications were found. Post-procedural FLR function, calculated with (99m) Tc-Mebrofenin hepatobiliary scintigraphy, and kinetic growth rate, at both timepoints, were greater in the LVD cohort (3.12 ± 0.55%/min/m2 vs. 2.46 ± 0.64%/min/m2, p = 0.041; 27.32 ± 16.86%/week (T1) vs. 15.71 ± 9.82%/week (T1) p < 0.001; 17.19 ± 9.88%/week (T2) vs. 9.89 ± 14.62%/week (T2) p = 0.034) when compared with the PVE cohort. Post-procedural FTR volumes were similar for both hypertrophy techniques. Conclusions: LVD is an effective procedure to effectively optimize FLR before liver resection for PHC. The faster growth rate combined with the improved FLR function, when compared to PVE alone, could maximize surgical outcomes by lowering post-hepatectomy liver failure rates.
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Affiliation(s)
- Rebecca Marino
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, 20132 Milan, Italy; (R.M.); (F.R.); (L.C.)
| | - Francesca Ratti
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, 20132 Milan, Italy; (R.M.); (F.R.); (L.C.)
| | - Angelo Della Corte
- Department of Radiology, IRCCS San Raffaele Hospital, 20132 Milan, Italy; (A.D.C.); (D.S.); (F.D.C.)
- Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Domenico Santangelo
- Department of Radiology, IRCCS San Raffaele Hospital, 20132 Milan, Italy; (A.D.C.); (D.S.); (F.D.C.)
- Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Lucrezia Clocchiatti
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, 20132 Milan, Italy; (R.M.); (F.R.); (L.C.)
| | - Carla Canevari
- Nuclear Medicine Department, San Raffaele University and Research Hospital, 20132 Milan, Italy; (C.C.); (P.M.)
| | - Patrizia Magnani
- Nuclear Medicine Department, San Raffaele University and Research Hospital, 20132 Milan, Italy; (C.C.); (P.M.)
| | - Federica Pedica
- Pathology Unit, Department of Experimental Oncology, San Raffaele Hospital, 20132 Milan, Italy;
| | | | - Francesco De Cobelli
- Department of Radiology, IRCCS San Raffaele Hospital, 20132 Milan, Italy; (A.D.C.); (D.S.); (F.D.C.)
- Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- Faculty of Medicine, University Vita-Salute San Raffaele, 20132 Milan, Italy
| | - Luca Aldrighetti
- Department of Radiology, IRCCS San Raffaele Hospital, 20132 Milan, Italy; (A.D.C.); (D.S.); (F.D.C.)
- Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- Faculty of Medicine, University Vita-Salute San Raffaele, 20132 Milan, Italy
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Rodimova S, Mozherov A, Elagin V, Karabut M, Shchechkin I, Kozlov D, Krylov D, Gavrina A, Bobrov N, Zagainov V, Zagaynova E, Kuznetsova D. Effect of Hepatic Pathology on Liver Regeneration: The Main Metabolic Mechanisms Causing Impaired Hepatic Regeneration. Int J Mol Sci 2023; 24:ijms24119112. [PMID: 37298064 DOI: 10.3390/ijms24119112] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/15/2023] [Accepted: 05/17/2023] [Indexed: 06/12/2023] Open
Abstract
Liver regeneration has been studied for many decades, and the mechanisms underlying regeneration of normal liver following resection are well described. However, no less relevant is the study of mechanisms that disrupt the process of liver regeneration. First of all, a violation of liver regeneration can occur in the presence of concomitant hepatic pathology, which is a key factor reducing the liver's regenerative potential. Understanding these mechanisms could enable the rational targeting of specific therapies to either reduce the factors inhibiting regeneration or to directly stimulate liver regeneration. This review describes the known mechanisms of normal liver regeneration and factors that reduce its regenerative potential, primarily at the level of hepatocyte metabolism, in the presence of concomitant hepatic pathology. We also briefly discuss promising strategies for stimulating liver regeneration and those concerning methods for assessing the regenerative potential of the liver, especially intraoperatively.
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Affiliation(s)
- Svetlana Rodimova
- Institute of Experimental Oncology and Biomedical Technologies, Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Sq., 603000 Nizhny Novgorod, Russia
| | - Artem Mozherov
- Institute of Experimental Oncology and Biomedical Technologies, Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Sq., 603000 Nizhny Novgorod, Russia
- Laboratory of Molecular Genetic Research, Institute of Clinical Medicine, N.I. Lobachevsky Nizhny Novgorod National Research State University, 23 Gagarina Ave., 603022 Nizhny Novgorod, Russia
| | - Vadim Elagin
- Institute of Experimental Oncology and Biomedical Technologies, Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Sq., 603000 Nizhny Novgorod, Russia
| | - Maria Karabut
- Institute of Experimental Oncology and Biomedical Technologies, Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Sq., 603000 Nizhny Novgorod, Russia
| | - Ilya Shchechkin
- Institute of Experimental Oncology and Biomedical Technologies, Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Sq., 603000 Nizhny Novgorod, Russia
- Laboratory of Molecular Genetic Research, Institute of Clinical Medicine, N.I. Lobachevsky Nizhny Novgorod National Research State University, 23 Gagarina Ave., 603022 Nizhny Novgorod, Russia
| | - Dmitry Kozlov
- Institute of Experimental Oncology and Biomedical Technologies, Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Sq., 603000 Nizhny Novgorod, Russia
- Laboratory of Molecular Genetic Research, Institute of Clinical Medicine, N.I. Lobachevsky Nizhny Novgorod National Research State University, 23 Gagarina Ave., 603022 Nizhny Novgorod, Russia
| | - Dmitry Krylov
- Institute of Experimental Oncology and Biomedical Technologies, Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Sq., 603000 Nizhny Novgorod, Russia
- Laboratory of Molecular Genetic Research, Institute of Clinical Medicine, N.I. Lobachevsky Nizhny Novgorod National Research State University, 23 Gagarina Ave., 603022 Nizhny Novgorod, Russia
| | - Alena Gavrina
- Institute of Experimental Oncology and Biomedical Technologies, Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Sq., 603000 Nizhny Novgorod, Russia
- Laboratory of Molecular Genetic Research, Institute of Clinical Medicine, N.I. Lobachevsky Nizhny Novgorod National Research State University, 23 Gagarina Ave., 603022 Nizhny Novgorod, Russia
| | - Nikolai Bobrov
- Institute of Experimental Oncology and Biomedical Technologies, Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Sq., 603000 Nizhny Novgorod, Russia
- The Volga District Medical Centre of Federal Medical and Biological Agency, 14 Ilinskaya St., 603000 Nizhny Novgorod, Russia
| | - Vladimir Zagainov
- Institute of Experimental Oncology and Biomedical Technologies, Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Sq., 603000 Nizhny Novgorod, Russia
- Nizhny Novgorod Regional Clinical Oncologic Dispensary, Delovaya St., 11/1, 603126 Nizhny Novgorod, Russia
| | - Elena Zagaynova
- Institute of Experimental Oncology and Biomedical Technologies, Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Sq., 603000 Nizhny Novgorod, Russia
| | - Daria Kuznetsova
- Institute of Experimental Oncology and Biomedical Technologies, Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Sq., 603000 Nizhny Novgorod, Russia
- Laboratory of Molecular Genetic Research, Institute of Clinical Medicine, N.I. Lobachevsky Nizhny Novgorod National Research State University, 23 Gagarina Ave., 603022 Nizhny Novgorod, Russia
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Iwaki K, Kaihara S, Kita R, Kitamura K, Hashida H, Uryuhara K. Indocyanine green plasma clearance rate and 99mTc-galactosyl human serum albumin single-photon emission computed tomography evaluated preoperative remnant liver. World J Clin Cases 2022; 10:8844-8853. [PMID: 36157637 PMCID: PMC9477059 DOI: 10.12998/wjcc.v10.i25.8844] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 03/22/2022] [Accepted: 07/25/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Preoperative evaluation of future remnant liver reserves is important for safe hepatectomy. If the remnant is small, preoperative portal vein embolization (PVE) is useful. Liver volume analysis has been the primary method of preoperative evaluation, although functional examination may be more accurate. We have used the functional evaluation liver using the indocyanine green plasma clearance rate (KICG) and 99mTc-galactosyl human serum albumin single-photon emission computed tomography (99mTc-GSA SPECT) for safe hepatectomy.
AIM To analyze the safety of our institution’s system for evaluating the remnant liver reserve.
METHODS We retrospectively reviewed the records of 23 patients who underwent preoperative PVE. Two types of remnant liver KICG were defined as follows: Anatomical volume remnant KICG (a-rem-KICG), determined as the remnant liver anatomical volume rate × KICG; and functional volume remnant KICG (f-rem-KICG), determined as the remnant liver functional volume rate based on 99mTc-GSA SPECT × KICG. If either of the remnant liver KICGs were > 0.05, a hepatectomy was performed. Perioperative factors were analyzed. We defined the marginal group as patients with a-rem-KICG of < 0.05 and a f-rem-KICG of > 0.05 and compared the postoperative outcomes between the marginal and not marginal (both a-rem-KICG and f-rem-KICG > 0.05) groups.
RESULTS All 23 patients underwent planned hepatectomies. Right hepatectomy, right trisectionectomy and left trisectionectomy were in 16, 6 and 1 cases, respectively. The mean of blood loss and operative time were 576 mL and 474 min, respectively. The increased amount of f-rem-KICG was significantly larger than that of a-rem-KICG after PVE (0.034 vs 0.012, P = 0.0273). The not marginal and marginal groups had 17 (73.9%) and 6 (26.1%) patients, respectively. The complications of Clavian-Dindo classification grade II or higher and post-hepatectomy liver failure were observed in six (26.1%) and one (grade A, 4.3%) patient, respectively. The 90-d mortality was zero. The marginal group had no significant difference in postoperative outcomes (prothrombin time/international normalised ratio, total bilirubin, complication, post-hepatectomy liver failure, hospital stay, 90-d, and mortality) compared with the not-marginal group.
CONCLUSION Functional evaluation of the remnant liver enabled safe hepatectomy and may extend the indication for hepatectomy after PVE treatment.
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Affiliation(s)
- Kentaro Iwaki
- Department of Surgery, Kobe City Medical Center General Hospital, Kobe 650-0046, Hyogo, Japan
| | - Satoshi Kaihara
- Department of Surgery, Kobe City Medical Center General Hospital, Kobe 650-0046, Hyogo, Japan
| | - Ryosuke Kita
- Department of Surgery, Kobe City Medical Center General Hospital, Kobe 650-0046, Hyogo, Japan
| | - Koji Kitamura
- Department of Surgery, Kobe City Medical Center General Hospital, Kobe 650-0046, Hyogo, Japan
| | - Hiroki Hashida
- Department of Surgery, Kobe City Medical Center General Hospital, Kobe 650-0046, Hyogo, Japan
| | - Kenji Uryuhara
- Department of Surgery, Kobe City Medical Center General Hospital, Kobe 650-0046, Hyogo, Japan
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Sumiyoshi T, Uemura K, Kondo N, Okada K, Seo S, Otsuka H, Serikawa M, Ishii Y, Tsuboi T, Murakami Y, Takahashi S. Is surgery justified for elderly patients with extrahepatic cholangiocarcinoma? Reappraisal from a viewpoint of comorbidity and organ function. Surg Today 2021; 51:1787-1794. [PMID: 34420113 DOI: 10.1007/s00595-021-02340-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 02/15/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The benefit of surgery for older patients with extrahepatic cholangiocarcinoma (EHCC) has not been established and the differences in the general condition of younger vs. older patients remain unclear. METHODS Patients who underwent curative surgery for EHCC were divided into two groups according to age: those younger than 75 years old (younger group) and those aged 75 years or older (older group). We analyzed the clinical data of the two groups retrospectively. RESULTS Among the 116 patients analyzed, 45 (38.8%) were in the older group. Regarding comorbidity, only cardiac disease was significantly more common in the older patients; however, the cardiac function of the two groups was identical. There were no significant differences in the prevalence of kidney and lung disease, but renal function was significantly deteriorated and the incidence of the mixed ventilatory defect was significantly greater in the older group. The overall 5-year survival rates for the younger and older groups were 52.4% vs. 50.4% of all cholangiocarcinoma patients (p = 0.458), 42.4% vs. 51.3% of those with hilar cholangiocarcinoma (p = 0.718), and 69.0% vs. 49.1% of those with distal cholangiocarcinoma (p = 0.534), respectively. CONCLUSIONS Improved survival after surgery can be expected in well-selected older cholangiocarcinoma patients. Comorbidities were not necessarily reflected in organ function, with precise organ function assessment being more important when selecting surgical candidates.
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Affiliation(s)
- Tatsuaki Sumiyoshi
- Department of Surgery, Graduate School of Biomedical and Health Science, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Kenichiro Uemura
- Department of Surgery, Graduate School of Biomedical and Health Science, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
| | - Naru Kondo
- Department of Surgery, Graduate School of Biomedical and Health Science, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Kenjiro Okada
- Department of Surgery, Graduate School of Biomedical and Health Science, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Shingo Seo
- Department of Surgery, Graduate School of Biomedical and Health Science, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Hiroyuki Otsuka
- Department of Surgery, Graduate School of Biomedical and Health Science, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Masahiro Serikawa
- Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Science, Hiroshima University, Hiroshima, Japan
| | - Yasutaka Ishii
- Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Science, Hiroshima University, Hiroshima, Japan
| | - Tomofumi Tsuboi
- Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Science, Hiroshima University, Hiroshima, Japan
| | - Yoshiaki Murakami
- Digestive Disease Center, Hiroshima Memorial Hospital, Hiroshima, Japan
| | - Shinya Takahashi
- Department of Surgery, Graduate School of Biomedical and Health Science, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
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6
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Sato N, Kenjo A, Suzushino S, Kimura T, Okada R, Ishigame T, Kofunato Y, Marubashi S. Predicting Post-Hepatectomy Liver Failure Using Intra-Operative Measurement of Indocyanine Green Clearance in Anatomical Hepatectomy. World J Surg 2021; 45:3660-3667. [PMID: 34392399 DOI: 10.1007/s00268-021-06289-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Prediction of post-hepatectomy liver failure (PHLF) based on remnant liver function reserve is important for successful hepatectomy. The aim of this study was to investigate whether intraoperative indocyanine green (ICG) clearance in a future remnant liver was a predictor of PHLF. METHODS This prospective study enrolled 31 consecutive patients who underwent anatomical hepatectomy between June 2016 and August 2019. Intraoperative ICG plasma disappearance rate (ICG-PDR) and ICG retention rate at 15 min (ICG-R15) were measured after clamping the selective hepatic inflow to the liver to be resected. The discriminative performance of the ICG-associated variables for the prediction of PHLF grade B/C was evaluated by receiver operator curve (ROC) analysis. RESULTS Of the operations performed, 87.1% were major hepatectomy. PHLF Grade B/C was observed in eight patients (25.8%) with no mortality. The concordance indices of intraoperative ICG-PDR and ICG-PDR for predicting PHLF were 0.834 (95% CI, 0.69-0.98) and 0.834 (95% CI, 0.69-0.98), respectively. A subgroup analysis of patients with preoperative biliary drainage (BD) (n = 17) showed that the concordance indices of intraoperative ICG-PDR increased to 0.923 (95% CI, 0.79-1.00). CONCLUSIONS Intraoperative ICG clearance in the remnant liver was a promising predictor for PHLF in patients undergoing anatomical hepatectomy, especially in patients with BD.
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Affiliation(s)
- Naoya Sato
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University, Hikarigaoka-1, Fukushima-shi, Fukushima, 960-1295, Japan
| | - Akira Kenjo
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University, Hikarigaoka-1, Fukushima-shi, Fukushima, 960-1295, Japan
| | - Seiko Suzushino
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University, Hikarigaoka-1, Fukushima-shi, Fukushima, 960-1295, Japan
| | - Takashi Kimura
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University, Hikarigaoka-1, Fukushima-shi, Fukushima, 960-1295, Japan
| | - Ryo Okada
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University, Hikarigaoka-1, Fukushima-shi, Fukushima, 960-1295, Japan
| | - Teruhide Ishigame
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University, Hikarigaoka-1, Fukushima-shi, Fukushima, 960-1295, Japan
| | - Yasuhide Kofunato
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University, Hikarigaoka-1, Fukushima-shi, Fukushima, 960-1295, Japan
| | - Shigeru Marubashi
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University, Hikarigaoka-1, Fukushima-shi, Fukushima, 960-1295, Japan.
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The value of 99mTc-labeled galactosyl human serum albumin single-photon emission computerized tomography/computed tomography on regional liver function assessment and posthepatectomy failure prediction in patients with hilar cholangiocarcinoma. Nucl Med Commun 2020; 41:1128-1135. [PMID: 32796452 DOI: 10.1097/mnm.0000000000001263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The aim was to evaluate the value of Tc-labeled galactosyl human serum albumin (Tc-GSA) with single-photon emission computerized tomography (SPECT) in the preoperative assessment of regional liver function and prediction of posthepatectomy liver failure (PHLF) in patients with hilar cholangiocarcinoma (hCCA). METHODS Patients with hCCA who underwent Tc-GSA SPECT/computed tomography (CT) before hepatectomy were included. The liver functional parameters of functional liver density (FLD) and predictive residual index (PRI) were calculated based on Tc-GSA SPECT/CT. PHLF was defined according to the International Study Group of Liver Surgery criteria. Univariate and multivariate analyses were used to analyze the risk factors for PHLF. The prediction of PHLF was calculated using receiver operating characteristic curve. RESULTS A total of 34 patients were included, 23 of whom underwent preoperative biliary drainage. FLD was significantly higher in patients with drained lobes than that in patients with undrained lobes (0.615 ± 0.190 versus 0.500 ± 0.211, P < 0.05). Sixteen patients suffered PHLF. The ratio of future remnant to total morphological liver volume, future remnant FLD, and PRI differed significantly in patients with and without PHLF according to univariate analysis. PRI was identified as the only independent factor for prediction of PHLF according to multivariate analysis. With a PRI of 0.78, it was possible to predict PHLF with a sensitivity of 83% and a specificity of 93%. CONCLUSIONS Tc-GSA SPECT/CT can accurately assess regional liver function and is better able to predict PHLF than conventional methods in patients with hCCA.
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Prediction of post-hepatectomy liver failure using gadoxetic acid-enhanced magnetic resonance imaging for hepatocellular carcinoma with portal vein invasion. Eur J Radiol 2020; 130:109189. [PMID: 32784077 DOI: 10.1016/j.ejrad.2020.109189] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 07/19/2020] [Accepted: 07/21/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE Accurate prediction of post-hepatectomy liver failure (PHLF) is important in advanced hepatocellular carcinoma (HCC). We aimed to retrospectively evaluate the utility of gadoxetic acid-enhanced MRI for predicting PHLF in patients who underwent anatomic hepatectomy for HCC with portal vein invasion. METHODS Forty-one patients (32 men, 9 women) were included. Hepatobiliary-phase MR images were acquired 20 min after injection of gadoxetic acid using a 3D fat-suppressed T1-weighted spoiled gradient-echo sequence. Liver-spleen ratio (LSR), remnant hepatocellular uptake index (rHUI), and HUI were calculated. The severity of PHLF was defined according to the International Study Group of Liver Surgery. Differences in LSR between the resected liver and the remnant liver, and HUI and rHUI/HUI between no/mild and severe PHLF were compared using the Wilcoxon signed-rank test and Wilcoxon rank-sum test, respectively. Univariate and multivariate logistic regression analyses were performed to identify predictors of severe PHLF. Areas under the receiver operating characteristic curves (AUCs) of rHUI and rHUI/HUI were calculated for predicting severe PHLF. RESULTS Nine patients developed severe PHLF. LSR of the remnant liver was significantly higher than that of the resected liver (P < 0.001). Severe PHLF demonstrated significantly lower rHUI (P < 0.001) and rHUI/HUI (P < 0.001) compared with no/mild PHLF. Multivariate logistic regression analysis showed that decreased rHUI (P = 0.012, AUC=0.885) and rHUI/HUI (P = 0.002, AUC=0.852) were independent predictors of severe PHLF. CONCLUSION Gadoxetic acid-enhanced MRI can be a promising noninvasive examination for assessing global and regional liver function, allowing estimation of the functional liver remnant and accurate prediction of severe PHLF before hepatic resection.
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Uemura S, Higuchi R, Yazawa T, Izumo W, Otsubo T, Yamamoto M. Level of total bilirubin in the bile of the future remnant liver of patients with obstructive jaundice undergoing hepatectomy predicts postoperative liver failure. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2020; 27:614-621. [PMID: 32506707 DOI: 10.1002/jhbp.784] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 04/17/2020] [Accepted: 04/22/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND We investigated whether the daily level of total bilirubin in the bile (LTB) excreted from the future remnant liver (FRL) can predict post-hepatectomy liver failure (PHLF) in patients with obstructive jaundice undergoing hepatectomy. METHODS Seventy-four patients who underwent biliary drainage and collection of bile juice from the FRL before undergoing right hepatectomy or right/left trisectionectomy with bile duct resection were included. The LTB from the FRL (mg/d) was calculated as the volume of the bile (dL) per day multiplied by the density of total bilirubin in the bile (mg/dL). We compared patients' characteristics with or without PHLF, which was defined as the total serum bilirubin level remaining >10 mg/dL after postoperative day 10. Then, pre- and intraoperative factors related to PHLF were examined. RESULTS PHLF was observed in six patients. LTB was significantly lower in the PHLF group. The LTB cut-off value for predicting PHLF, as determined using the receiver operating characteristic curve, was 56 mg/d. On multivariate analysis, LTB was found to be an independent risk factor for PHLF (P = .01, OR 35.88). CONCLUSIONS LTB may be a potential functional assessment in jaundiced patients before right hepatectomy and right/left trisectionectomy.
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Affiliation(s)
- Shuichiro Uemura
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Ryota Higuchi
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Takehisa Yazawa
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Wataru Izumo
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Takehito Otsubo
- Department of Gastroenterological and General Surgery, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Masakazu Yamamoto
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
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Tokorodani R, Sumiyoshi T, Okabayashi T, Hata Y, Noda Y, Morita S, Daisaki H, Okada Y, Yasuda E. Liver fibrosis assessment using 99mTc-GSA SPECT/CT fusion imaging. Jpn J Radiol 2019; 37:315-320. [DOI: 10.1007/s11604-019-00810-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 01/09/2019] [Indexed: 02/06/2023]
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Yoon JH, Lee JM, Kang HJ, Ahn SJ, Yang H, Kim E, Okuaki T, Han JK. Quantitative Assessment of Liver Function by Using Gadoxetic Acid-enhanced MRI: Hepatocyte Uptake Ratio. Radiology 2018; 290:125-133. [PMID: 30375932 DOI: 10.1148/radiol.2018180753] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Purpose To determine whether hepatocyte uptake ratios derived at gadoxetic acid-enhanced MRI correlate with quantitative measures of liver function and can help to identify contraindication to major hepatectomy. Materials and Methods Between August 2016 and October 2016, 50 study participants with chronic liver disease or cirrhosis underwent liver MRI at 3.0 T including T1 mapping and elastography. Liver function was quantitatively assessed by using the indocyanine green retention test (ICG R15). T1 maps were obtained by using the Look-Locker sequence before and 10 minutes after gadoxetic acid administration (0.025 mmol/kg). The relationship between ICG R15 and the following MRI parameters was evaluated: pre- and postcontrast T1 values of the liver, hepatocyte uptake ratio representing the amount of contrast media solely taken into hepatocytes, liver volume, and degree of enhancement at the common bile duct. Diagnostic performance of the hepatocyte uptake ratio to identify patients with ICG R15 greater than 20% (ie, contraindication to hepatectomy) was compared with other parameters by using areas under the receiver operating characteristic curve. Results Hepatocyte uptake ratio showed a negative correlation with ICG R15 r of -0.78 (P < .001). In participants with chronic liver disease or Child-Pugh class A, those with ICG R15 of 20% or less showed higher hepatocyte uptake ratio than those with ICG R15 greater than 20% (P < .001). Hepatocyte uptake ratios demonstrated better performance for helping to detect ICG R15 greater than 20% than did liver volume (area under the curve, 0.96 vs 0.70; P = .01). Conclusion Hepatocyte uptake ratios are negatively correlated with liver function as measured by indocyanine green retention test and provide acceptable diagnostic performance for helping to identify participants who have contraindications to major hepatectomy. © RSNA, 2018 Online supplemental material is available for this article. See also the editorial by Reeder in this issue.
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Affiliation(s)
- Jeong Hee Yoon
- From the Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (J.H.Y., J.M.L., H.J.K., S.J.A., H.Y., J.K.H.); Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (J.H.Y., J.M.L., H.J.K., S.J.A., H.Y., J.K.H.); Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (J.M.L.); Philips Healthcare Korea, Seoul, Korea (E.K.); and Philips Healthcare Japan, Tokyo, Japan (T.O.)
| | - Jeong Min Lee
- From the Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (J.H.Y., J.M.L., H.J.K., S.J.A., H.Y., J.K.H.); Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (J.H.Y., J.M.L., H.J.K., S.J.A., H.Y., J.K.H.); Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (J.M.L.); Philips Healthcare Korea, Seoul, Korea (E.K.); and Philips Healthcare Japan, Tokyo, Japan (T.O.)
| | - Hyo-Jin Kang
- From the Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (J.H.Y., J.M.L., H.J.K., S.J.A., H.Y., J.K.H.); Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (J.H.Y., J.M.L., H.J.K., S.J.A., H.Y., J.K.H.); Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (J.M.L.); Philips Healthcare Korea, Seoul, Korea (E.K.); and Philips Healthcare Japan, Tokyo, Japan (T.O.)
| | - Su Joa Ahn
- From the Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (J.H.Y., J.M.L., H.J.K., S.J.A., H.Y., J.K.H.); Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (J.H.Y., J.M.L., H.J.K., S.J.A., H.Y., J.K.H.); Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (J.M.L.); Philips Healthcare Korea, Seoul, Korea (E.K.); and Philips Healthcare Japan, Tokyo, Japan (T.O.)
| | - Hyunkyung Yang
- From the Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (J.H.Y., J.M.L., H.J.K., S.J.A., H.Y., J.K.H.); Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (J.H.Y., J.M.L., H.J.K., S.J.A., H.Y., J.K.H.); Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (J.M.L.); Philips Healthcare Korea, Seoul, Korea (E.K.); and Philips Healthcare Japan, Tokyo, Japan (T.O.)
| | - Eunju Kim
- From the Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (J.H.Y., J.M.L., H.J.K., S.J.A., H.Y., J.K.H.); Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (J.H.Y., J.M.L., H.J.K., S.J.A., H.Y., J.K.H.); Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (J.M.L.); Philips Healthcare Korea, Seoul, Korea (E.K.); and Philips Healthcare Japan, Tokyo, Japan (T.O.)
| | - Tomoyuki Okuaki
- From the Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (J.H.Y., J.M.L., H.J.K., S.J.A., H.Y., J.K.H.); Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (J.H.Y., J.M.L., H.J.K., S.J.A., H.Y., J.K.H.); Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (J.M.L.); Philips Healthcare Korea, Seoul, Korea (E.K.); and Philips Healthcare Japan, Tokyo, Japan (T.O.)
| | - Joon Koo Han
- From the Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (J.H.Y., J.M.L., H.J.K., S.J.A., H.Y., J.K.H.); Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (J.H.Y., J.M.L., H.J.K., S.J.A., H.Y., J.K.H.); Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (J.M.L.); Philips Healthcare Korea, Seoul, Korea (E.K.); and Philips Healthcare Japan, Tokyo, Japan (T.O.)
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Kotani K, Kawabe J, Higashiyama S, Yoshida A, Kawamura E, Tamori A, Shiomi S, Kawada N. Heterogeneous liver uptake of Tc-99m-GSA as quantified through SPECT/CT helps to evaluate the degree of liver fibrosis: A retrospective observational study. Medicine (Baltimore) 2018; 97:e11765. [PMID: 30075603 PMCID: PMC6081161 DOI: 10.1097/md.0000000000011765] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Tc-99m-galactosyl human serum albumin (GSA) scintigraphy is used to assess the hepatic functional reserve, and allows for visual assessment of the residual hepatocyte distribution on single-photon emission computed tomography/computed tomography (SPECT/CT) images. The association between heterogeneous liver uptake of Tc-99m-GSA and liver fibrosis remains to be studied in detail. We analyzed this association.Fifty-one patients with chronic hepatobiliary disease undergoing a Tc-99m-GSA scintigraphy were included in this study. The receptor (LHL15) and blood clearance (HH15) indexes (the uptake ratios of the liver and heart) were obtained from dynamic planar images. The liver uptake count maximum-to-mean ratio (LUC Max/Mean) was calculated from single-photon emission computed tomography/computed tomography (SPECT/CT) images as an indicator of the Tc-99m-GSA liver uptake heterogeneity. We assessed the relationship between these quantified values and liver fibrosis.There were 30 Child-Pugh classification grade A patients, 16 grade B patients, and 5 grade C patients. Among the 30 patients whose liver histopathology was evaluable, those with advanced liver fibrosis (F2-4) had a lower LHL15 than those with mild liver fibrosis (F0-1) (median, 0.90 vs. 0.92, P = .04), and a higher LUC Max/Mean (median, 1.80 vs. 1.70, P = .02). The multivariate analysis identified platelets (P = .04) and the LUC Max/Mean (P = .04) as contributing factors of advanced liver fibrosis.These findings suggest that Tc-99m-GSA SPECT/CT can be used not only to assess the hepatic functional reserve, but also to evaluate a degree of liver fibrosis.
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Affiliation(s)
- Kohei Kotani
- Department of Hepatology, Graduate School of Medicine
- Department of Nuclear Medicine, Graduate School of Medicine, Osaka City University
| | - Joji Kawabe
- Department of Nuclear Medicine, Graduate School of Medicine, Osaka City University
| | - Shigeaki Higashiyama
- Department of Nuclear Medicine, Graduate School of Medicine, Osaka City University
| | - Atsushi Yoshida
- Department of Nuclear Medicine, Graduate School of Medicine, Osaka City University
| | - Etsushi Kawamura
- Department of Gastroenterology and Hepatology, Osaka City Juso Hospital
| | | | - Susumu Shiomi
- Department of Gastroenterology and Hepatology, Izumiotsu Municipal Hospital, Osaka, Japan
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99mTc-GSA SPECT/CT fusion imaging for hepatectomy candidates with extremely deteriorated ICG value. Jpn J Radiol 2018; 36:537-543. [PMID: 29948545 DOI: 10.1007/s11604-018-0753-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 06/06/2018] [Indexed: 12/26/2022]
Abstract
PURPOSE The value of indocyanine green (ICG) test is negatively affected in patients with intrahepatic shunt, ICG excretory defect, or jaundice. This study evaluated 99mTc-GSA SPECT/CT fusion imaging for assessing liver function in patients with severely deteriorated ICG values. MATERIALS AND METHODS Thirteen hepatectomy candidates with ICG retention rates over 40% were retrospectively analyzed. The ICG clearance rate (KICG) and estimated KICG obtained by 99mTc-GSA scintigraphy (KGSA) were used to evaluate preoperative whole liver function. Remnant liver function was assessed using the remnant (rem) KICG (= KICG × volumetric rate) and remKGSA (= KGSA × functional rate) indices; hepatectomy was considered unsafe for values < 0.05. The correlations of remKICG and remKGSA with postoperative mortality and morbidity were also investigated. RESULTS KGSA values were significantly greater than KICG values (median: 0.12 vs. 0.059; p < 0.01); remKGSA values were greater than remKICG values in all patients (median: 0.107 vs. 0.0413; p < 0.01). Hepatectomy was considered unsafe in 70% patients using remKICG, and in none of those using remKGSA; liver failure or postoperative mortality did not occur. CONCLUSIONS 99mTc-GSA SPECT/CT fusion imaging enables more accurate liver function assessment than the ICG test in patients with severely deteriorated ICG values.
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Liu YS, Lin CY, Chuang MT, Tsai YS, Wang CK, Ou MC. Success and complications of percutaneous transhepatic biliary drainage are influenced by liver entry segment and level of catheter placement. Abdom Radiol (NY) 2018; 43:713-722. [PMID: 28741168 DOI: 10.1007/s00261-017-1258-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
PURPOSE To examine outcomes and complications of percutaneous transhepatic biliary drainage (PTBD) performed via the right or left lobe and different entry levels (lobar, segmental, subsegmental, sub-subsegmental). METHODS The records of patients who underwent PTBD for obstructive jaundice from 2008 to 2015 were retrospectively reviewed. Logistic regression analysis was performed to determine factors associated with outcomes and complications based on entry side and entry level. PTBD success was defined as a total bilirubin decrease after catheter placement. RESULTS The data of 446 patients (mean age 68.4 years) were included. Multivariate logistic regression revealed a decrease of bilirubin level was associated with left lobe (vs. right) entry [adjusted odds ratio (aOR) = 2.657, 95% confidence interval (CI) 1.160, 6.087], external drainage (aOR = 2.908, 95% CI 1.226, 6.897), and liver volume undrained <50% (aOR = 2.623, 95% CI 1.045, 6.581). PTBD success was increased with left lobe entry (aOR = 1.853, 95% CI 1.167, 2.940) and associated with entry level (subsegmental vs. lobar, aOR = 2.992, 95% CI 1.258, 7.114; sub-subsegmental vs. lobar, aOR = 3.711, 95% CI 1.383, 9.956). Complications were significantly decreased with left lobe entry (aOR = 0.450, 95% CI 0.263, 0.769) and associated with entry level (segmental vs. lobar, aOR = 0.359, 95% CI 0.148, 0.873; subsegmental vs. lobar, aOR = 0.248, 95% CI 0.10, 0.615; sub-subsegmental vs. lobar, aOR = 0.129, 95% CI 0.041, 0.411). CONCLUSIONS The success and complications of PTBD vary with entry side and level.
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Affiliation(s)
- Yi-Sheng Liu
- Department of Diagnostic Radiology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138 Sheng Li Road, Tainan, 704, Taiwan, ROC
| | - Chia-Ying Lin
- Department of Diagnostic Radiology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138 Sheng Li Road, Tainan, 704, Taiwan, ROC
| | - Ming-Tsung Chuang
- Department of Diagnostic Radiology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138 Sheng Li Road, Tainan, 704, Taiwan, ROC
| | - Yi-Shan Tsai
- Department of Diagnostic Radiology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138 Sheng Li Road, Tainan, 704, Taiwan, ROC
| | - Chien-Kuo Wang
- Department of Diagnostic Radiology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138 Sheng Li Road, Tainan, 704, Taiwan, ROC
| | - Ming-Ching Ou
- Department of Diagnostic Radiology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138 Sheng Li Road, Tainan, 704, Taiwan, ROC.
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Nakamura I, Iimuro Y, Hai S, Kondo Y, Hatano E, Fujimoto J. Impaired Value of 99m Tc-GSA Scintigraphy as an Independent Risk Factor for Posthepatectomy Liver Failure in Patients with Hepatocellular Carcinoma. Eur Surg Res 2018; 59:12-22. [PMID: 29332090 DOI: 10.1159/000484044] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 10/06/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Posthepatectomy liver failure (PHLF) was recently defined with the corresponding recommendations as follows: grade A, no change in clinical management; grade B, clinical management with noninvasive treatment; and grade C, clinical management with invasive treatment. In this study, we identified the risk factors for grade B and C PHLF in patients with hepatocellular carcinoma (HCC). METHODS Of 339 HCC patients who underwent curative hepatic resection, 218 were included for analysis. The LHL15 index (uptake ratio of the liver to that of the liver and heart at 15 min) was measured by 99m Tc-GSA (99m technetium-labelled galactosyl human serum albumin); remnant LHL15 was calculated as LHL15 × [1 - (resected liver weight - tumor volume)/whole liver volume without tumor]. RESULTS A total of 163 patients were classified as having no PHLF, whereas 17, 37, and 1 patient had PHLF grade A, B, and C, respectively. There were significant differences in indocyanine green R15, serum albumin, prothrombin time, Child-Pugh classification, LHL15 and remnant LHL15 between patients with grades B/C PHLF and patients with grade A or no PHLF. Only remnant LHL15 was identified as an independent risk factor for grades B/C PHLF (p = 0.023), with a cut-off value of 0.755. CONCLUSIONS Remnant LHL15 was an independent risk factor for grades B/C PHLF. Patients with impaired remnant LHL15 value of <0.755 should be carefully monitored for PHLF.
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Abstract
Preoperative estimation of future remnant liver function is critical for major hepatic surgery to avoid postoperative morbidity and mortality. Among several liver function tests, the indocyanine green (ICG) clearance test is still the most popular dynamic method. The usefulness of ICG clearance test parameters, such as ICGR15, KICG, or PDRICG, has been reported by many investigators. The transcutaneous non-invasive pulse dye densitometry system has made the ICG clearance test more convenient and attractive, even in Western countries. The concept of future remnant KICG (rem KICG), which combines the functional aspect and the volumetric factor of the future remnant liver, seems ideal for determining the maximum extent of major hepatic resection that will not cause postoperative liver failure. For damaged livers with functional heterogeneity among the hepatic segments, fusion images combining technetium-99m-diethylenetriaminepentaacetic acid-galactosyl human serum albumin single photon emission computed tomography (99mTc-GSA SPECT) and X-ray CT are helpful to precisely estimate the functional reserve of the future remnant liver. Another technique for image-based liver function estimation, gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid(Gd-EOB)-enhanced magnetic resonance imaging, may be an ideal candidate for the preoperative determination of future remnant liver function. Using these methods effectively, morbidity and mortality after major hepatic resection could be reduced.
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Affiliation(s)
- Yuji Iimuro
- Department of Surgery, Hepato-Biliary-Pancreatic Disease Center, Yamanashi Prefectural Central Hospital, Yamanashi, Japan
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Quantitative assessment of liver function with whole-liver T1rho mapping at 3.0T. Magn Reson Imaging 2017; 46:75-80. [PMID: 29109053 DOI: 10.1016/j.mri.2017.10.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Revised: 10/20/2017] [Accepted: 10/31/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To assess the segmental liver function in healthy subjects and liver cirrhosis (LC) patients with different Child-Pugh grades using whole-liver T1rho mapping at 3.0T. METHODS Thirty-three healthy volunteers and 33 patients with clinically diagnosed LC were examined using a three-dimensional (3D) whole-liver coverage T1rho mapping. T1rho maps were calculated from five respiratory-triggered sequences with different spin-lock durations (0, 10, 20, 40, and 60ms). The patients were classified into group A with Child-Pugh A cirrhosis and group B with Child-Pugh B or C cirrhosis. The hepatic T1rho values in different segments of the healthy volunteers and LC patients were compared, and receiver operating characteristic curves (ROC) were plotted to determine the performance of T1rho. RESULTS The median T1rho value of the patients (Child-Pugh class A: 47.07ms; Child-Pugh classes B and C: 51.09ms) was significantly higher than that of the healthy volunteers (39.37ms, P<0.001). No remarkable variations among different hepatic segments in LC patients with various Child-Pugh grades were found (P>0.05). The T1rho values of the liver parenchyma were significantly correlated with albumin (r=-0.590, P<0.001) and prothrombin time (r=0.601, P<0.001). The T1rho values in patients increased with an increase in the Child-Pugh classification (r=0.574, P<0.001). CONCLUSIONS The whole-liver coverage T1rho sequence at 3.0T was feasible for the assessment of segmental liver function. T1rho relaxation might be a potential biomarker for the estimation of liver function in LC patients.
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A novel utility of 99mTc-GSA SPECT/CT fusion imaging: detection of inadequate portal vein embolization. Jpn J Radiol 2017; 35:748-754. [PMID: 29039109 DOI: 10.1007/s11604-017-0689-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 09/22/2017] [Indexed: 12/11/2022]
Abstract
PURPOSE Our aim was to determine the utility of Tc-99m-diethylenetriaminepentaacetic acid-galactosyl human serum albumin single-photon-emission computed tomography (99mTc-GSA SPECT/CT) fusion imaging for detecting incomplete portal vein embolization (PVE). MATERIALS AND METHODS Fifty-five candidates underwent PVE. Among them, five underwent second PVE. Detectability of first inadequate PVE using CT and 99mTc-GSA SPECT/CT fusion imaging was analyzed. RESULTS Cases of inadequate PVE were detected in three patients using CT and in five using 99mTc-GSA SPECT/CT fusion imaging. Fusion imaging detected two cases of insufficient PVE in which portal branches were apparently well embolized on CT. Median value for volumetric rate in the embolized liver was 63.3% after the first PVE and 54.7% after the second (P < 0.01). Median functional rate value in embolized liver was 60.1% after the first PVE and 49.4% after the second (P < 0.01). Median value for change of volumetric and functional rates in embolized liver after the second PVE was 7.1 and 10.3%, respectively, and change of functional rate was greater than that of volumetric rate (P < 0.01). CONCLUSIONS 99mTc-GSA SPECT/CT fusion imaging was useful for detecting inadequate PVE, and second PVE was effective for increasing volumetric and functional rates.
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Liver Function Assessment Using Technetium 99m-Galactosyl Single-Photon Emission Computed Tomography/CT Fusion Imaging: A Prospective Trial. J Am Coll Surg 2017; 225:789-797. [PMID: 28912030 DOI: 10.1016/j.jamcollsurg.2017.08.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 08/24/2017] [Accepted: 08/25/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND The prediction of postoperative liver function remains a largely subjective practice based on CT volumetric analysis. However, future liver volume after a hepatectomy is not the only factor that contributes to postoperative liver function and outcomes. STUDY DESIGN In this prospective trial, 185 consecutive patients who underwent liver operations between 2014 and 2015 were studied. Volumetric and functional rates of remnant liver were measured using technetium 99m-galactosyl human serum albumin single-photon emission computed tomography/CT fusion imaging to evaluate post-hepatectomy remnant liver function. Remnant indocyanine green clearance rate using galactosyl (KGSA) (KGSA × functional rate) was used to predict future remnant liver function. Hepatectomy was considered safe for patients with remnant KGSA values ≥0.05, and the primary end point was to determine the accuracy and reliability of this criteria. The prediction of the 90-day major complication and mortality rates was assessed. RESULTS Median hospital stay was 9 days and median ICU stay was 1 day, with only 1 in-hospital death (90-day mortality rate 0.5%). Overall morbidity rate evaluated according to the Clavien-Dindo classification was 9%. For post-hepatectomy liver failure definitions, the International Study Group of Liver Surgery definition was fulfilled in 14 patients (8%), with the majority being grade B (50%), compared with 2 patients (1%) fulfilling the "50-50" criteria, and 0 patients (0%) fulfilling the PeakBili >7 criteria. CONCLUSIONS Results of this study showed that remnant KGSA provided information that allowed us to predict remnant liver function. This information will be important for surgeons when deciding on a treatment plan for patients with liver diseases. (ClinicalTrials.gov ID: NCT02013895).
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Yoon JH, Lee JM, Kim E, Okuaki T, Han JK. Quantitative Liver Function Analysis: Volumetric T1 Mapping with Fast Multisection B 1 Inhomogeneity Correction in Hepatocyte-specific Contrast-enhanced Liver MR Imaging. Radiology 2016; 282:408-417. [PMID: 27697007 DOI: 10.1148/radiol.2016152800] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Purpose To determine whether B1 inhomogeneity-corrected volumetric T1 maps of gadoxetic acid-enhanced liver magnetic resonance (MR) imaging are able to demonstrate global liver function and functional heterogeneity in patients with cirrhosis and to investigate their relationship with the development of hepatic insufficiency and decompensation. Materials and Methods This institutional review board-approved retrospective study with waiver of informed consent included 234 consecutive patients who underwent gadoxetic acid-enhanced liver MR imaging, including B1 inhomogeneity-corrected volumetric T1 mapping. For all patients, T1 relaxation times of the liver and liver volumes were measured on T1 maps. Liver T1 and functional liver volume-to-weight ratio (liver volume divided by liver T1 and the patient's weight) were compared between Child-Pugh class A and class B cirrhosis. Associations between serum markers, MR parameters, hepatic insufficiency, and decompensation were investigated by using Cox proportional hazards analysis. Results Patients with Child-Pugh class B disease showed significantly longer liver T1 (548.2 msec ± 257.7 vs 372.2 msec ± 77.5, P < .0001) and lower kurtosis of liver T1 (29.1 ± 39.6 vs 43.9 ± 64.9, P = .016) than patients with Child-Pugh class A disease. Prolonged liver T1 (≥462 msec) (hazard ratio [HR], 5.9; 95% confidence interval [CI]: 1.1, 62.8) and an albumin level of less than 3.5 g/dL (HR, 20.7; 95% CI: 3.9, 221.9) were independently associated with the development of hepatic insufficiency. Functional liver volume-to-weight ratio was associated with the development of hepatic decompensation in patients with Child-Pugh class A disease (HR, 0.03; 95% CI: 0.004, 0.23). Conclusion B1 inhomogeneity-corrected volumetric T1 mapping provided information on global liver function and demonstrated functional heterogeneity. In addition, prolonged liver T1 (≥462 msec) was associated with the development of hepatic insufficiency, and functional liver volume-to-weight ratio was negatively related with the development of decompensation in compensated cirrhosis. © RSNA, 2016 Online supplemental material is available for this article.
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Affiliation(s)
- Jeong Hee Yoon
- From the Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (J.H.Y., J.M.L., J.K.H.); Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (J.H.Y., J.M.L., J.K.H.); Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (J.M.L., J.K.H.); Philips Healthcare Korea, Seoul, Korea (E.K.); and Philips Healthcare Japan, Tokyo, Japan (T.O.)
| | - Jeong Min Lee
- From the Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (J.H.Y., J.M.L., J.K.H.); Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (J.H.Y., J.M.L., J.K.H.); Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (J.M.L., J.K.H.); Philips Healthcare Korea, Seoul, Korea (E.K.); and Philips Healthcare Japan, Tokyo, Japan (T.O.)
| | - Eunju Kim
- From the Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (J.H.Y., J.M.L., J.K.H.); Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (J.H.Y., J.M.L., J.K.H.); Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (J.M.L., J.K.H.); Philips Healthcare Korea, Seoul, Korea (E.K.); and Philips Healthcare Japan, Tokyo, Japan (T.O.)
| | - Tomoyuki Okuaki
- From the Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (J.H.Y., J.M.L., J.K.H.); Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (J.H.Y., J.M.L., J.K.H.); Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (J.M.L., J.K.H.); Philips Healthcare Korea, Seoul, Korea (E.K.); and Philips Healthcare Japan, Tokyo, Japan (T.O.)
| | - Joon Koo Han
- From the Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (J.H.Y., J.M.L., J.K.H.); Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (J.H.Y., J.M.L., J.K.H.); Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (J.M.L., J.K.H.); Philips Healthcare Korea, Seoul, Korea (E.K.); and Philips Healthcare Japan, Tokyo, Japan (T.O.)
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Sumiyoshi T, Shima Y, Okabayashi T, Kozuki A, Hata Y, Noda Y, Kouno M, Miyagawa K, Tokorodani R, Saisaka Y, Tokumaru T, Nakamura T, Morita S. Liver function assessment using 99mTc-GSA single-photon emission computed tomography (SPECT)/CT fusion imaging in hilar bile duct cancer: A retrospective study. Surgery 2016; 160:118-126. [PMID: 27059635 DOI: 10.1016/j.surg.2016.02.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Revised: 02/03/2016] [Accepted: 02/03/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND The objective of this study was to determine the utility of Tc-99m-diethylenetriamine-penta-acetic acid-galactosyl human serum albumin ((99m)Tc-GSA) single-photon emission computed tomography (SPECT)/CT fusion imaging for posthepatectomy remnant liver function assessment in hilar bile duct cancer patients. METHODS Thirty hilar bile duct cancer patients who underwent major hepatectomy with extrahepatic bile duct resection were retrospectively analyzed. Indocyanine green plasma clearance rate (KICG) value and estimated KICG by (99m)Tc-GSA scintigraphy (KGSA) and volumetric and functional rates of future remnant liver by (99m)Tc-GSA SPECT/CT fusion imaging were used to evaluate preoperative whole liver function and posthepatectomy remnant liver function, respectively. Remnant (rem) KICG (= KICG × volumetric rate) and remKGSA (= KGSA × functional rate) were used to predict future remnant liver function; major hepatectomy was considered unsafe for values <0.05. The correlation of remKICG and remKGSA with posthepatectomy mortality and morbidity was determined. RESULTS Although remKICG and remKGSA were not significantly different (median value: 0.071 vs 0.075), functional rates of future remnant liver were significantly higher than volumetric rates (median: 0.54 vs 0.46; P < .001). Hepatectomy was considered unsafe in 17% and 0% of patients using remKICG and remKGSA, respectively. Postoperative liver failure and mortality did not occur in the patients for whom hepatectomy was considered unsafe based on remKICG. remKGSA showed a stronger correlation with postoperative prothrombin time activity than remKICG. CONCLUSION (99m)Tc-GSA SPECT/CT fusion imaging enables accurate assessment of future remnant liver function and suitability for hepatectomy in hilar bile duct cancer patients.
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Affiliation(s)
- Tatsuaki Sumiyoshi
- Department of Gastroenterological Surgery, Kochi Health Sciences Center, Kochi, Japan.
| | - Yasuo Shima
- Department of Gastroenterological Surgery, Kochi Health Sciences Center, Kochi, Japan
| | - Takehiro Okabayashi
- Department of Gastroenterological Surgery, Kochi Health Sciences Center, Kochi, Japan
| | - Akihito Kozuki
- Department of Gastroenterological Surgery, Kochi Health Sciences Center, Kochi, Japan
| | - Yasuhiro Hata
- Department of Radiology, Kochi Health Sciences Center, Kochi, Japan
| | - Yoshihiro Noda
- Department of Radiology, Kochi Health Sciences Center, Kochi, Japan
| | - Michihiko Kouno
- Department of Radiology, Kochi Health Sciences Center, Kochi, Japan
| | | | | | - Yuichi Saisaka
- Department of Gastroenterological Surgery, Kochi Health Sciences Center, Kochi, Japan
| | - Teppei Tokumaru
- Department of Gastroenterological Surgery, Kochi Health Sciences Center, Kochi, Japan
| | - Toshio Nakamura
- Department of Gastroenterological Surgery, Kochi Health Sciences Center, Kochi, Japan
| | - Sojiro Morita
- Department of Radiology, Kochi Health Sciences Center, Kochi, Japan
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Iida T, Yagi S, Hori T, Uemoto S. Significance of (99m)Tc-GSA liver scintigraphy in liver surgery and transplantation. ANNALS OF TRANSLATIONAL MEDICINE 2015; 3:16. [PMID: 25738136 DOI: 10.3978/j.issn.2305-5839.2015.01.07] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Accepted: 12/09/2014] [Indexed: 12/21/2022]
Affiliation(s)
- Taku Iida
- 1 Hepato-Biliary-Pancreatic and Transplant Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan ; 2 Department of Surgery, Kitano Hospital Medical Research Institute, Osaka, Japan
| | - Shintaro Yagi
- 1 Hepato-Biliary-Pancreatic and Transplant Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan ; 2 Department of Surgery, Kitano Hospital Medical Research Institute, Osaka, Japan
| | - Tomohide Hori
- 1 Hepato-Biliary-Pancreatic and Transplant Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan ; 2 Department of Surgery, Kitano Hospital Medical Research Institute, Osaka, Japan
| | - Shinji Uemoto
- 1 Hepato-Biliary-Pancreatic and Transplant Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan ; 2 Department of Surgery, Kitano Hospital Medical Research Institute, Osaka, Japan
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