Risk assessment of posthepatectomy liver failure using hepatobiliary scintigraphy and CT volumetry.
A major part of morbidity and mortality after liver resections is caused by inadequate remnant liver function leading to liver failure. It is therefore important to develop accurate diagnostic tools that can predict the risk of liver resection-related morbidity and mortality. In this study, preoperative hepatobiliary scintigraphy of the future remnant liver and CT volumetric measurement of the future remnant liver were performed on patients who were to undergo liver resection. The accuracy of risk assessment for postoperative morbidity, liver failure, and mortality was evaluated.


METHODS
Forty-six patients who were scheduled for liver resection because of hepatobiliary tumors, including 17 patients with parenchymal disease (37%) and 13 patients with hilar cholangiocarcinoma (28%), were assessed preoperatively. Hepatobiliary scintigraphy was performed by drawing regions of interest around the future remnant to calculate (99m)Tc-mebrofenin uptake in it. CT volumetry was used to measure the volume of the total liver, the tumors, and the future remnant. Receiver-operating-characteristic analysis was performed to assess cutoff values for risk assessment of morbidity, liver failure, and mortality. Furthermore, univariate and multivariate analyses were performed to determine factors related to morbidity and mortality.


RESULTS
Morbidity and mortality rates were 61% and 11%, respectively. Liver failure occurred in 6 patients (13%). Significantly decreased uptake in the future remnant was found in patients in whom liver failure and liver failure-related mortality developed (P=0.003 and 0.02, respectively). The volume of the future remnant was not significantly associated with any of the outcome parameters. In receiver-operating-characteristic analysis, uptake cutoff values for liver failure and liver failure-related mortality were 2.5%/min/body surface area and 2.2%/min/body surface area, respectively. In multivariate analysis, uptake was the only significant factor associated with liver failure.


CONCLUSIONS
Preoperative measurement of (99m)Tc-mebrofenin uptake in the future remnant liver on hepatobiliary scintigraphy proved more valuable than measurement of the volume of the future remnant on CT in assessing the risk of liver failure and liver failure-related mortality after partial liver resection.
Dinant
Sander
S
Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands. s_dinant@hotmail.com
de Graaf
Wilmar
W
Verwer
Bart J
BJ
Bennink
Roelof J
RJ
van Lienden
Krijn P
KP
Gouma
Dirk J
DJ
van Vliet
Arlène K
AK
van Gulik
Thomas M
TM
D000328:Adult; D000368:Aged; D000814:Aniline Compounds; D001659:Biliary Tract / Q000000981:diagnostic imaging; D015897:Comorbidity; D005260:Female; D005998:Glycine; D006498:Hepatectomy / Q000401:mortality*; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000706:statistics & numerical data; D007098:Imino Acids; D008099:Liver / Q000000981:diagnostic imaging; D017093:Liver Failure / Q000401:mortality*; D008113:Liver Neoplasms / Q000401:mortality* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D015609:Organotechnetium Compounds; D011379:Prognosis; D011877:Radionuclide Imaging / Q000706:statistics & numerical data*; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D015996:Survival Rate; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*
D000814:Aniline Compounds; D007098:Imino Acids; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; C034837:technetium Tc 99m mebrofenin; D005998:Glycine