title: Significance of functional hepatic resection rate calculated using 3D CT/(99m)Tc-galactosyl human serum albumin single-photon emission computed tomography fusion imaging.
abstract: OBJECTIVE
  To evaluate the usefulness of the functional hepatic resection rate (FHRR) calculated using 3D computed tomography (CT)/(99m)Tc-galactosyl-human serum albumin (GSA) single-photon emission computed tomography (SPECT) fusion imaging for surgical decision making.
  
  
  METHODS
  We enrolled 57 patients who underwent bi- or trisectionectomy at our institution between October 2013 and March 2015. Of these, 26 patients presented with hepatocellular carcinoma, 12 with hilar cholangiocarcinoma, six with intrahepatic cholangiocarcinoma, four with liver metastasis, and nine with other diseases. All patients preoperatively underwent three-phase dynamic multidetector CT and (99m)Tc-GSA scintigraphy. We compared the parenchymal hepatic resection rate (PHRR) with the FHRR, which was defined as the resection volume counts per total liver volume counts on 3D CT/(99m)Tc-GSA SPECT fusion images.
  
  
  RESULTS
  In total, 50 patients underwent bisectionectomy and seven underwent trisectionectomy. Biliary reconstruction was performed in 15 patients, including hepatopancreatoduodenectomy in two. FHRR and PHRR were 38.6 ± 19.9 and 44.5 ± 16.0, respectively; FHRR was strongly correlated with PHRR. The regression coefficient for FHRR on PHRR was 1.16 (P < 0.0001). The ratio of FHRR to PHRR for patients with preoperative therapies (transcatheter arterial chemoembolization, radiation, radiofrequency ablation, etc.), large tumors with a volume of > 1000 mL, and/or macroscopic vascular invasion was significantly smaller than that for patients without these factors (0.73 ± 0.19 vs 0.82 ± 0.18, P < 0.05). Postoperative hyperbilirubinemia was observed in six patients. Major morbidities (Clavien-Dindo grade ≥ 3) occurred in 17 patients (29.8%). There was no case of surgery-related death.
  
  
  CONCLUSIONS
  Our results suggest that FHRR is an important deciding factor for major hepatectomy, because FHRR and PHRR may be discrepant owing to insufficient hepatic inflow and congestion in patients with preoperative therapies, macroscopic vascular invasion, and/or a tumor volume of > 1000 mL.
authors.affiliation: Yosuke Tsuruga, Toshiya Kamiyama, Hirofumi Kamachi, Shingo Shimada, Kenji Wakayama, Tatsuya Orimo, Tatsuhiko Kakisaka, Hideki Yokoo, Akinobu Taketomi, Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Japan.
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Tsuruga
authors.affiliation: Yosuke Tsuruga, Toshiya Kamiyama, Hirofumi Kamachi, Shingo Shimada, Kenji Wakayama, Tatsuya Orimo, Tatsuhiko Kakisaka, Hideki Yokoo, Akinobu Taketomi, Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Japan.
authors.forename: Toshiya
authors.initials: T
authors.lastname: Kamiyama
authors.affiliation: Yosuke Tsuruga, Toshiya Kamiyama, Hirofumi Kamachi, Shingo Shimada, Kenji Wakayama, Tatsuya Orimo, Tatsuhiko Kakisaka, Hideki Yokoo, Akinobu Taketomi, Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Japan.
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Kamachi
authors.affiliation: Yosuke Tsuruga, Toshiya Kamiyama, Hirofumi Kamachi, Shingo Shimada, Kenji Wakayama, Tatsuya Orimo, Tatsuhiko Kakisaka, Hideki Yokoo, Akinobu Taketomi, Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Japan.
authors.forename: Shingo
authors.initials: S
authors.lastname: Shimada
authors.affiliation: Yosuke Tsuruga, Toshiya Kamiyama, Hirofumi Kamachi, Shingo Shimada, Kenji Wakayama, Tatsuya Orimo, Tatsuhiko Kakisaka, Hideki Yokoo, Akinobu Taketomi, Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Wakayama
authors.affiliation: Yosuke Tsuruga, Toshiya Kamiyama, Hirofumi Kamachi, Shingo Shimada, Kenji Wakayama, Tatsuya Orimo, Tatsuhiko Kakisaka, Hideki Yokoo, Akinobu Taketomi, Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Japan.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Orimo
authors.affiliation: Yosuke Tsuruga, Toshiya Kamiyama, Hirofumi Kamachi, Shingo Shimada, Kenji Wakayama, Tatsuya Orimo, Tatsuhiko Kakisaka, Hideki Yokoo, Akinobu Taketomi, Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Japan.
authors.forename: Tatsuhiko
authors.initials: T
authors.lastname: Kakisaka
authors.affiliation: Yosuke Tsuruga, Toshiya Kamiyama, Hirofumi Kamachi, Shingo Shimada, Kenji Wakayama, Tatsuya Orimo, Tatsuhiko Kakisaka, Hideki Yokoo, Akinobu Taketomi, Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Yokoo
authors.affiliation: Yosuke Tsuruga, Toshiya Kamiyama, Hirofumi Kamachi, Shingo Shimada, Kenji Wakayama, Tatsuya Orimo, Tatsuhiko Kakisaka, Hideki Yokoo, Akinobu Taketomi, Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Japan.
authors.forename: Akinobu
authors.initials: A
authors.lastname: Taketomi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000706:statistics & numerical data*; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D008875:Middle Aged; D000072098:Single Photon Emission Computed Tomography Computed Tomography / Q000379:methods*; D013668:Technetium Tc 99m Aggregated Albumin; D016284:Technetium Tc 99m Pentetate
chemical_list: D013668:Technetium Tc 99m Aggregated Albumin; C070561:technetium Tc 99m DTPA-galactosyl-human serum albumin; D016284:Technetium Tc 99m Pentetate
keywords: 99mTc-galactosyl human serum albumin; Functional hepatic resection rate; Hepatectomy; Parenchymal hepatic resection rate; Single-photon emission computed tomography