99mTc-Galactosyl sialyl albumin (GSA) scintigram adjusts hepatic resection range in ICG based estimation.
OBJECTIVE
Indocyanin Green (ICG)-based diagnosis is widely accepted in determination of hepatic resection range, however, we frequently encounter scattered results of preoperative assessment. The aim of this study was to clarify the role of 99mTc Galactosyl sialyl albumin (GSA) scintigram in the decision of the resection range.


METHODS
One hundred and eighty patients who underwent liver resection were included in this study. The patients were divided according to ICGR15 value as follows; Group 1 (n=100): ICG R15 <15%, Group 2 (n=32): ICGR15 15-20%, Group 3 (n=32): ICGR15 20-25% and Group 4 (n=8): ICGR15 >25%. Each group was divided into two subgroups by their GSA-LHL 0.9 levels and compared with regards to liver function, portal pressure and HAI score of background liver. The frequency of complications was also compared to previous cases without GSA-LHL estimation (n=64).


RESULTS
In Groups 2 and 3, the GSA-LHL ≥ 0.9 subgroup showed better platelet counts, portal pressure and lower HAI score. In groups of GSA-LHL ≥ 0.9, platelet counts showed higher value between below 20% of ICGR15 and above that, while GSA-LHL<0.9 showed no difference in groups exceeding 15% of ICGR15. Overall complications occurred less in GSA-LHL ≥ 0.9 compared to previous cases without GSA-LHL estimation.


CONCLUSIONS
Levels of GSA-LHL reflects severity of portal hypertension in moderately damaged liver preoperatively and could contribute to the decision of the range of resection with low morbidity.
Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
Yukio
Y
Kamohara
Mitsuhisa
M
Takatsuki
Masaaki
M
Hidaka
Akihiko
A
Soyama
Takashi
T
Kanematsu
Susumu
S
Eguchi
D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D007208:Indocyanine Green; D008099:Liver / Q000000981:diagnostic imaging*; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals; D013668:Technetium Tc 99m Aggregated Albumin; D016284:Technetium Tc 99m Pentetate; D014057:Tomography, X-Ray Computed
D019275:Radiopharmaceuticals; D013668:Technetium Tc 99m Aggregated Albumin; C070561:technetium Tc 99m DTPA-galactosyl-human serum albumin; D007208:Indocyanine Green; D016284:Technetium Tc 99m Pentetate