title: Preoperative regional maximal removal rate of technetium-99m-galactosyl human serum albumin (GSA-Rmax) is useful for judging the safety of hepatic resection.
abstract: BACKGROUND
  For hepatic resection, the preoperative estimation of hepatic functional reserve in the predicted remnant liver may be more important than that of the entire liver. We evaluated the maximal removal rate of technetium-99m-galactosyl-human serum albumin (GSA-Rmax) in the remnant.
  
  
  METHODS
  One hundred and seventy-eight patients were admitted for elective hepatectomy. Conventional liver function, and 15-minute retention rate of indocyanine green (ICGR15) were carried out preoperatively. The GSA-Rmax was calculated according to a radiopharmacokinetic model; then we used the single photon emission computed tomography images to calculate the regional GSA-Rmax in the predicted residual liver (GSA-RL), depending on the operative procedures. The volume of the predicted residual liver (LV-RL) was calculated on the basis of computed tomography images.
  
  
  RESULTS
  The preoperative LV-RL correlated well with the GSA-RL in patients with normal liver; however, there was no such correlation in those with chronic hepatitis or cirrhosis. All of 7 postoperative hyperbilirubinemia occurred in the patients with GSA-RL < 0.15. Two patients died of postoperative liver failure 1 to 2 months after the operation. These 2 patients had GSA-RL values of 0.078 and 0.090, respectively, and severe discrepancies between the GSA-Rmax in the remnant liver and ICGR15.
  
  
  CONCLUSIONS
  We concluded that GSA-RL may be useful for determining the procedure of hepatectomy and that the value should be maintained at greater than 0.15 to avoid postoperative hyperbilirubinemia or hepatic failure.
authors.affiliation: Department of Surgery, Kansai Medical University, Moriguchi, Osaka, Japan. kon@takii.kmu.ac.jp
authors.forename: A-Hon
authors.initials: AH
authors.lastname: Kwon
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Matsui
authors.forename: Masaki
authors.initials: M
authors.lastname: Kaibori
authors.forename: Sang Kil
authors.initials: SK
authors.lastname: Ha-Kawa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D022781:Hepatocytes / Q000378:metabolism; D006801:Humans; D006932:Hyperbilirubinemia / Q000517:prevention & control; D007208:Indocyanine Green / Q000493:pharmacokinetics; D008099:Liver / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000601:surgery*; D017093:Liver Failure / Q000517:prevention & control; D008297:Male; D008657:Metabolic Clearance Rate; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods*; D019275:Radiopharmaceuticals / Q000493:pharmacokinetics*; D012189:Retrospective Studies; D013668:Technetium Tc 99m Aggregated Albumin / Q000493:pharmacokinetics*; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods
chemical_list: D019275:Radiopharmaceuticals; D013668:Technetium Tc 99m Aggregated Albumin; D007208:Indocyanine Green