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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Published in:Surgery Vol. 162; no. 4; pp. 775 - 783
Main Authors: 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
Format: Journal Article
Language:English
Published: United States Elsevier Inc 01.10.2017
Elsevier
Subjects:
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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Summary: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.
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ISSN:0039-6060
1532-7361
1532-7361
DOI:10.1016/j.surg.2017.05.022