title: Predictors of successful hepatic resection: prognostic usefulness of hepatic asialoglycoprotein receptor analysis.
abstract: To test the clinical usefulness of hepatic asialogycoprotein receptor analysis in liver surgery, we have conducted univariate and multivariate analysis for the detection of cirrhotic patients and prediction of morbidity after hepatic resection. Liver scintigraphy using technetium 99m-labeled asialoglycoprotein analog (TcGSA), ICG test, and CT hepatic volumetry were undertaken in 158 surgical patients including 111 who underwent hepatic resection. Hepatic functional parameters including Child-Pugh score, indocyanine green retention at 15 minutes (ICG-R15), clearance index (HH15), receptor index (LHL15), receptor concentration ([R]0), total hepatic receptor amount (R0) and hepatic parenchymal volume (HPV) were compared among patients with normal, cirrhotic, and non-cirrhotic damaged liver. Preoperative hepatic functional parameters, resected parenchymal fraction (RPf), operative blood loss, and total receptor amount of the remnant liver (R0-remnant) were compared between patients with and without signs of postoperative liver failure. All parameters but HPV were significantly different among patients with normal, cirrhotic, and noncirrhotic damaged liver. The multivariate analysis selected two significant (p <0.05) parameters, [R]0 and Child-Pugh score for the detection of liver cirrhosis. Of the 111 patients who underwent resection, 14 developed transient signs of postoperative liver failure. Of the parameters tested, presence of liver cirrhosis, LHL15, R0, intraoperative blood loss, and R0-remnant were significantly different between patients with and without signs of postoperative liver failure (p <0.05). The multivariate logistic regression analysis selected only R0-remnant as a significant (p = 0.022) parameter for the prediction of liver failure. The morbidity rate in patients with R0-remnant under 0.05 mmoles was 100%, and the rate decreased in inverse proportion to R0-remnant. In conclusion, combining the ASGP-R concentration ([R]0) and the Child-Pugh score best detected liver cirrhosis in surgical candidates. Cirrhotic patients and patients with a low R0-remnant are at higher risk for postoperative liver failure. The present study confirms the usefulness of hepatic asialogycoprotein receptor analysis in liver surgery.
authors.affiliation: Department of Surgery, Cancer Institute Hospital, 1-37-1 Kami-Ikebukuro, Toshima-ku, Tokyo, Japan 170-8455. kokudo-2su@h.u-tokyo.ac.jp
authors.forename: Norihiro
authors.initials: N
authors.lastname: Kokudo
authors.forename: David R
authors.initials: DR
authors.lastname: Vera
authors.forename: Keiichiro
authors.initials: K
authors.lastname: Tada
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Koizumi
authors.forename: Makoto
authors.initials: M
authors.lastname: Seki
authors.forename: Toshiki
authors.initials: T
authors.lastname: Matsubara
authors.forename: Hirotoshi
authors.initials: H
authors.lastname: Ohta
authors.forename: Toshiharu
authors.initials: T
authors.lastname: Yamaguchi
authors.forename: Takashi
authors.initials: T
authors.lastname: Takahashi
authors.forename: Toshifusa
authors.initials: T
authors.lastname: Nakajima
authors.forename: Tetsuichiro
authors.initials: T
authors.lastname: Muto
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D037263:Asialoglycoprotein Receptor / Q000378:metabolism*; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects; D006801:Humans; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000601:surgery*; D017093:Liver Failure / Q000209:etiology; D008111:Liver Function Tests / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011877:Radionuclide Imaging / Q000379:methods; D019275:Radiopharmaceuticals; D013668:Technetium Tc 99m Aggregated Albumin; D016284:Technetium Tc 99m Pentetate
chemical_list: D037263:Asialoglycoprotein Receptor; D019275:Radiopharmaceuticals; D013668:Technetium Tc 99m Aggregated Albumin; C070561:technetium Tc 99m DTPA-galactosyl-human serum albumin; D016284:Technetium Tc 99m Pentetate