Hepatobiliary scintigraphy to evaluate liver function in associating liver partition and portal vein ligation for staged hepatectomy: Liver volume overestimates liver function

Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) induces a rapid and extensive increase in liver volume. The functional quality of this hypertrophic response has been called into question because ALPPS is associated with a substantial incidence of liver failure and...

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Vydané v:	Surgery Ročník 162; číslo 4; s. 775 - 783
Hlavní autori:	Olthof, Pim B., Tomassini, Federico, Huespe, Pablo E., Truant, Stephanie, Pruvot, François-René, Troisi, Roberto I., Castro, Carlos, Schadde, Erik, Axelsson, Rimma, Sparrelid, Ernesto, Bennink, Roelof J., Adam, Rene, van Gulik, Thomas M., de Santibanes, Eduardo
Médium:	Journal Article
Jazyk:	English
Vydavateľské údaje:	United States Elsevier Inc 01.10.2017 Elsevier
Predmet:	Aged Female Hepatectomy - adverse effects Humans Life Sciences Ligation Liver - pathology Liver Failure - diagnostic imaging Liver Failure - etiology Liver Function Tests Liver Neoplasms - diagnostic imaging Liver Neoplasms - pathology Liver Neoplasms - surgery Liver Regeneration Male Middle Aged Organ Size Portal Vein Postoperative Complications - diagnostic imaging Postoperative Complications - etiology Radionuclide Imaging Tomography, X-Ray Computed Treatment Outcome
ISSN:	0039-6060, 1532-7361, 1532-7361
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Abstract	Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) induces a rapid and extensive increase in liver volume. The functional quality of this hypertrophic response has been called into question because ALPPS is associated with a substantial incidence of liver failure and high perioperative mortality. This multicenter study aimed to evaluate functional liver regeneration in contrast to volumetric liver regeneration in ALPPS, using technetium-99m hepatobiliary scintigraphy and computed tomography volumetry, respectively. Patients who underwent ALPPS and hepatobiliary scintigraphy in 6 centers were included. Hepatobiliary scintigraphy data were analyzed centrally at the Academic Medical Center in Amsterdam according to established protocols. Increase in liver function as measured by hepatobiliary scintigraphy after stage 1 of ALPPS was compared with the increase in liver volume. In addition, we analyzed the impact of liver function and volume on postoperative outcomes including liver failure, morbidity, and mortality. In 60 patients, future liver remnant volume increased by a median 78% (interquartile range 48–110) during a median 8 (interquartile range 6–14) days after stage 1, while function as measured by hepatobiliary scintigraphy increased by a median 29% (interquartile range 1–55) throughout 7 days (interquartile range 6–10) in the 27 patients with paired measurements. After stage 2 of ALPPS, liver failure occurred in 5/60 (8%) patients, severe complications in 24/60 (40%), and mortality occurred in 4/60 (7%). In ALPPS, volumetry overestimates liver function as measured by hepatobiliary scintigraphy and may be responsible for the high rate of liver failure. Quantitative liver function tests are highly recommended to avoid post hepatectomy liver failure.
AbstractList	Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) induces a rapid and extensive increase in liver volume. The functional quality of this hypertrophic response has been called into question because ALPPS is associated with a substantial incidence of liver failure and high perioperative mortality. This multicenter study aimed to evaluate functional liver regeneration in contrast to volumetric liver regeneration in ALPPS, using technetium-99m hepatobiliary scintigraphy and computed tomography volumetry, respectively. Patients who underwent ALPPS and hepatobiliary scintigraphy in 6 centers were included. Hepatobiliary scintigraphy data were analyzed centrally at the Academic Medical Center in Amsterdam according to established protocols. Increase in liver function as measured by hepatobiliary scintigraphy after stage 1 of ALPPS was compared with the increase in liver volume. In addition, we analyzed the impact of liver function and volume on postoperative outcomes including liver failure, morbidity, and mortality. In 60 patients, future liver remnant volume increased by a median 78% (interquartile range 48–110) during a median 8 (interquartile range 6–14) days after stage 1, while function as measured by hepatobiliary scintigraphy increased by a median 29% (interquartile range 1–55) throughout 7 days (interquartile range 6–10) in the 27 patients with paired measurements. After stage 2 of ALPPS, liver failure occurred in 5/60 (8%) patients, severe complications in 24/60 (40%), and mortality occurred in 4/60 (7%). In ALPPS, volumetry overestimates liver function as measured by hepatobiliary scintigraphy and may be responsible for the high rate of liver failure. Quantitative liver function tests are highly recommended to avoid post hepatectomy liver failure. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) induces a rapid and extensive increase in liver volume. The functional quality of this hypertrophic response has been called into question because ALPPS is associated with a substantial incidence of liver failure and high perioperative mortality. This multicenter study aimed to evaluate functional liver regeneration in contrast to volumetric liver regeneration in ALPPS, using technetium-99m hepatobiliary scintigraphy and computed tomography volumetry, respectively.BACKGROUNDAssociating liver partition and portal vein ligation for staged hepatectomy (ALPPS) induces a rapid and extensive increase in liver volume. The functional quality of this hypertrophic response has been called into question because ALPPS is associated with a substantial incidence of liver failure and high perioperative mortality. This multicenter study aimed to evaluate functional liver regeneration in contrast to volumetric liver regeneration in ALPPS, using technetium-99m hepatobiliary scintigraphy and computed tomography volumetry, respectively.Patients who underwent ALPPS and hepatobiliary scintigraphy in 6 centers were included. Hepatobiliary scintigraphy data were analyzed centrally at the Academic Medical Center in Amsterdam according to established protocols. Increase in liver function as measured by hepatobiliary scintigraphy after stage 1 of ALPPS was compared with the increase in liver volume. In addition, we analyzed the impact of liver function and volume on postoperative outcomes including liver failure, morbidity, and mortality.METHODSPatients who underwent ALPPS and hepatobiliary scintigraphy in 6 centers were included. Hepatobiliary scintigraphy data were analyzed centrally at the Academic Medical Center in Amsterdam according to established protocols. Increase in liver function as measured by hepatobiliary scintigraphy after stage 1 of ALPPS was compared with the increase in liver volume. In addition, we analyzed the impact of liver function and volume on postoperative outcomes including liver failure, morbidity, and mortality.In 60 patients, future liver remnant volume increased by a median 78% (interquartile range 48-110) during a median 8 (interquartile range 6-14) days after stage 1, while function as measured by hepatobiliary scintigraphy increased by a median 29% (interquartile range 1-55) throughout 7 days (interquartile range 6-10) in the 27 patients with paired measurements. After stage 2 of ALPPS, liver failure occurred in 5/60 (8%) patients, severe complications in 24/60 (40%), and mortality occurred in 4/60 (7%).RESULTSIn 60 patients, future liver remnant volume increased by a median 78% (interquartile range 48-110) during a median 8 (interquartile range 6-14) days after stage 1, while function as measured by hepatobiliary scintigraphy increased by a median 29% (interquartile range 1-55) throughout 7 days (interquartile range 6-10) in the 27 patients with paired measurements. After stage 2 of ALPPS, liver failure occurred in 5/60 (8%) patients, severe complications in 24/60 (40%), and mortality occurred in 4/60 (7%).In ALPPS, volumetry overestimates liver function as measured by hepatobiliary scintigraphy and may be responsible for the high rate of liver failure. Quantitative liver function tests are highly recommended to avoid post hepatectomy liver failure.CONCLUSIONIn ALPPS, volumetry overestimates liver function as measured by hepatobiliary scintigraphy and may be responsible for the high rate of liver failure. Quantitative liver function tests are highly recommended to avoid post hepatectomy liver failure.
Author	Olthof, Pim B. Axelsson, Rimma Bennink, Roelof J. Sparrelid, Ernesto de Santibanes, Eduardo Pruvot, François-René Troisi, Roberto I. van Gulik, Thomas M. Castro, Carlos Adam, Rene Schadde, Erik Huespe, Pablo E. Tomassini, Federico Truant, Stephanie
Author_xml	– sequence: 1 givenname: Pim B. surname: Olthof fullname: Olthof, Pim B. email: pb.olthof@amc.nl organization: Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands – sequence: 2 givenname: Federico surname: Tomassini fullname: Tomassini, Federico organization: Department of General, HPB and Liver Transplantation Surgery, Ghent University Hospital Medical School, Ghent, Belgium – sequence: 3 givenname: Pablo E. surname: Huespe fullname: Huespe, Pablo E. organization: Department of Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina – sequence: 4 givenname: Stephanie surname: Truant fullname: Truant, Stephanie organization: Department of Digestive Surgery and Transplantation, University of Lille Nord de France, Lille, France – sequence: 5 givenname: François-René surname: Pruvot fullname: Pruvot, François-René organization: Department of Digestive Surgery and Transplantation, University of Lille Nord de France, Lille, France – sequence: 6 givenname: Roberto I. surname: Troisi fullname: Troisi, Roberto I. organization: Department of General, HPB and Liver Transplantation Surgery, Ghent University Hospital Medical School, Ghent, Belgium – sequence: 7 givenname: Carlos surname: Castro fullname: Castro, Carlos organization: Centre Hépato-Biliaire, Hôpital Paul Brousse, Hôpitaux de Paris Université Paris-Sud, Villejuif, France – sequence: 8 givenname: Erik surname: Schadde fullname: Schadde, Erik organization: Department of Surgery, Division of Transplantation, Rush University Medical Center, Chicago, IL – sequence: 9 givenname: Rimma surname: Axelsson fullname: Axelsson, Rimma organization: Department of Clinical Science, Intervention and Technology, Division of Radiology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden – sequence: 10 givenname: Ernesto surname: Sparrelid fullname: Sparrelid, Ernesto organization: Department of Clinical Science, Intervention and Technology, Division of Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden – sequence: 11 givenname: Roelof J. surname: Bennink fullname: Bennink, Roelof J. organization: Department of Nuclear Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands – sequence: 12 givenname: Rene surname: Adam fullname: Adam, Rene organization: Centre Hépato-Biliaire, Hôpital Paul Brousse, Hôpitaux de Paris Université Paris-Sud, Villejuif, France – sequence: 13 givenname: Thomas M. surname: van Gulik fullname: van Gulik, Thomas M. organization: Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands – sequence: 14 givenname: Eduardo surname: de Santibanes fullname: de Santibanes, Eduardo organization: Department of Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Snippet	Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) induces a rapid and extensive increase in liver volume. The functional...
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SubjectTerms	Aged Female Hepatectomy - adverse effects Humans Life Sciences Ligation Liver - pathology Liver Failure - diagnostic imaging Liver Failure - etiology Liver Function Tests Liver Neoplasms - diagnostic imaging Liver Neoplasms - pathology Liver Neoplasms - surgery Liver Regeneration Male Middle Aged Organ Size Portal Vein Postoperative Complications - diagnostic imaging Postoperative Complications - etiology Radionuclide Imaging Tomography, X-Ray Computed Treatment Outcome
Title	Hepatobiliary scintigraphy to evaluate liver function in associating liver partition and portal vein ligation for staged hepatectomy: Liver volume overestimates liver function
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