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Clearance of the liver remnant predicts short-term outcome in patients undergoing resection of hepatocellular carcinoma

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World Journal of Gastroenterology 2022年第38期28卷 5614-5625页

作者： Atsushi Miki Yasunaru Sakuma Hideyuki Ohzawa Akira Saito Yoshiyuki Meguro Jun Watanabe Kazue Morishima Kazuhiro Endo Hideki Sasanuma Atsushi Shimizu Alan Kawarai Lefor Yoshikazu Yasuda Naohiro Sata Department of Surgery Jichi Medical UniversityShimotsuke 329-0498TochigiJapan

BACKGROUND Estimation of the functional reserve of the remnant liver is important to reduce morbidity and mortality.AIM To estimate the functional reserve of the remnant liver in patients with hepatocellular carcinoma(HCC).METHODS We reviewed the medical records of 199 patients who underwent resection of HCC.Hepatic clearance of the remnant liver was calculated using fusion images of 99mTc-labelled galactosyl-human serum albumin liver scintigraphy and computed tomography.Posthepatectomy liver failure(PHLF)was classified according to the International Study Group of Liver Surgery.Complications was classified according to Clavien–Dindo classification.We analyzed by the risk factors for PHLF,morbidity and mortality with multivariate analysis.RESULTS Twenty-seven(30%)patients had major complications and 23(12%)developed PHLF.The incidence of major complications increased with increasing albumin–bilirubin(ALBI)grade.The area under the curve values for hepatic clearance of the remnant liver,liver to heart-plus-liver radioactivity at 15 min(LHL15),and ALBI score predicting PHLF were 0.868,0.629,and 0.655,respectively.The area under the curve for hepatic clearance of the remnant liver,LHL15,and ALBI score predicting major complications were 0.758,0.594,and 0.647,respectively.The risk factors for PHLF and major complications were hepatic clearance of the remnant liver and intraoperative bleeding.CONCLUSION The measurement of hepatic clearance may predict PHLF and major complications for patients undergoing resection of HCC.

关键词： Liver function Hepatectomy Cirrhosis fusion image Complication Mortality

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Preoperative liver functional volumetry performed by 3D-99mTc-GSA scintigraphy/vascular fusion imaging using SYNAPSE VINCENT: a preliminary study

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Hepatoma Research 2016年第1期2卷 187-192页

作者： Hiroshi Yoshida Hiroshi Makino Tadashi Yokoyama Hiroshi Maruyama Atsushi Hirakata Junji Ueda Yasuhiro Mamada Nobuhiko Taniai Eiji Uchida Department of Surgery Nippon Medical School Tama Nagayama HospitalTokyo 206-8512Japan Department of Surgery Nippon Medical SchoolTokyo 113-8603Japan

Aim:The present study was designed to evaluate the feasibility of preoperative liver functional volumetry performed by 3D-technetium-99m-diethylenetriaminepentaacetic acid-galactosyl-human serum albumin(99mTc-GSA)scintigraphy/vascular fusion imaging using SYNAPSE VINCENT and to examine the discrepancy between conventional and functional volumetry.Methods:The study group comprised 15 patients who underwent preoperative 3-dimensional(3D)-99mTc-GSA scintigraphy/vascular fusion imaging using SYNAPSE VINCENT software before hepatectomy between July 2014 and August 2015.The diagnosis was hepatocellular carcinoma(n=4),metastatic liver tumor(n=10),or intrahepatic cholangiocarcinoma(n=1).Right hepatectomy was performed in 2 patients,left hepatectomy in 3 patients,right posterior sectionectomy in 3 patients,segmentectomy in 2 patients,and partial hepatectomy in 4 patients.99mTc-GSA scintigraphy and computed tomography(CT)were performed to construct 3D-99mTc-GSA scintigraphy/vascular fused images.The conventional volume ratio of the planned resection region without tumor(%CT),and the functional volume ratio of the planned resection region without tumor(%GSA)were calculated.The discrepancy ratio was calculated as follows:discrepancy ratio=100-%GSA/%CT×100(%).Results:The%GSA(17.9±16.7%)was significantly lower than the%CT(21.5±17.6%)(Pimages constructed using SYNAPSE VINCENT were useful for noninvasively performing functional liver volumetry in patients scheduled to undergo various patterns of hepatectomy.In planned resection regions without tumor,the functional volume ratio was about 20%lower than the conventional volume ratio.

关键词： Functional volumetry 99m-diethylenetriaminepentaacetic acid-galactosyl-human serum albumin SYNAPSE VINCENT fusion image 3-dimensional computed tomography

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