Journal of the American College of Surgeons
Journal of the American College of Surgeons
5 years ago

Liver Function Assessment Using Technetium-99m-Galactosyl Single Photon Emission CT/CT Fusion Imaging: A Prospective Trial

The prediction of postoperative liver function remains a largely subjective practice based on computed tomography (CT) volumetric analysis. However, the future liver volume after a hepatectomy is not the only factor that contributes to postoperative liver function and outcomes. Study design In this prospective trial, 185 consecutive patients who underwent liver surgery between 2014 and 2015 were studied. Volumetric and functional rates of remnant liver were measured using technetium-99m-galactosyl human serum albumin single photon emission computed tomography/computed tomography (99mTc-GSA SPECT/CT) fusion imaging to evaluate post-hepatectomy remnant liver function. Remnant (rem) KGSA (= KGSA × functional rate) was used to predict future remnant liver function. Hepatectomy was considered safe for patients with values >0.05, and the primary endpoint was to determine the accuracy and reliability of this criteria. The prediction of the 90-day major complication rate and mortality rate were assessed. Results The median hospital stay was 9 days and median intensive care unit stay was 1 day, with only one in-hospital death (90-day mortality rate=0.5%). The overall morbidity rate evaluated according to the Clavien-Dindo classification was 9%. Regarding post-hepatectomy liver failure definitions, the International Study Group of Liver Surgery Group (ISGLS) definition was fulfilled in 14 patients (8%), with the majority being grade B (50%), compared with 2 patients (1%) fulfilling the ‘50-50’ criteria, and 0 patients (0%) fulfilled the PeakBili >7 criteria. Conclusions The results of this study showed that remKGSA provided information that allowed us to predict remnant liver function. This information will be important for surgeons when deciding on a treatment plan for patients with liver diseases.

Publisher URL: www.sciencedirect.com/science

DOI: S1072751517319269

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