Yao Siyuan, Taura Kojiro, Yoh Tomoaki, Nishio Takahiro, Koyama Yukinori, Ogiso Satoshi, Okamoto Tatsuya, Fukumitsu Ken, Ishii Takamichi, Seo Satoru, Hata Koichiro, Masui Toshihiko, Shimizu Hironori, Ishimori Takayoshi, Hatano Etsuro
Department of Surgery, Graduate School of Medicine, Kyoto University Japan; Department of Surgery, Kobe City Medical Center West Hospital, Hyogo, Japan.
Department of Surgery, Graduate School of Medicine, Kyoto University Japan.
Surgery. 2023 Feb;173(2):435-441. doi: 10.1016/j.surg.2022.10.005. Epub 2022 Nov 11.
Technetium-99m-galactosyl human serum albumin scintigraphy is preferred for assessing the liver functional reserve in patients undergoing hepatectomy, but its superiority over computed tomography volumetry after portal vein embolization and subsequent hepatectomy remains elusive. We aimed to compare technetium-99m-galactosyl human serum albumin scintigraphy with conventional computed tomography volumetry for predicting posthepatectomy liver failure in patients after portal vein embolization.
This retrospective study analyzed 152 consecutive patients who underwent hepatobiliary cancer resection after portal vein embolization between 2006 and 2021. Posthepatectomy liver failure was graded according to the International Study Group of Liver Surgery criteria. The predictive abilities for posthepatectomy liver failure were compared between the future remnant uptake (%) by technetium-99m-galactosyl human serum albumin scintigraphy and the future remnant volume (%) by computed tomography volumetry.
Future remnant uptake (%) was significantly greater than future remnant volume (%) after portal vein embolization (47.9% vs 40.8%; P < .001), while the values were comparable before portal vein embolization (32.7% vs 31.2%; P = .116). Receiver operating characteristic curve analysis revealed that post-portal vein embolization future remnant volume (%) had a significantly higher area under the curve than post-portal vein embolization future remnant uptake (%) (0.709 vs 0.630; P = .046) for predicting posthepatectomy liver failure. Multivariable analysis revealed that post-portal vein embolization future remnant volume (%) independently predicted posthepatectomy liver failure, but future remnant uptake (%) did not. Although the incidence of posthepatectomy liver failure grade ≥B was 17.8% when indocyanine green-clearance of the future liver remnant based on both future remnant volume (%) and future remnant uptake (%) was ≥0.05, it was higher in other combinations: 55.6% for indocyanine green clearance of the remnant volume ≥0.05/indocyanine green clearance of the remnant uptake ≤0.05; 50.0% for indocyanine green clearance of the remnant volume ≤0.05/indocyanine green clearance of the remnant uptake ≥0.05; and 50% for indocyanine green clearance of the remnant volume ≤0.05/indocyanine green clearance of the remnant uptake ≤0.05.
Technetium-99m-galactosyl human serum albumin scintigraphy is not superior to computed tomography volumetry for assessing the future liver remnant in patients undergoing major hepatectomy after portal vein embolization.
锝-99m-半乳糖基人血清白蛋白闪烁扫描术是评估肝切除患者肝功能储备的首选方法，但其在门静脉栓塞及后续肝切除术后相对于计算机断层扫描容积测量法的优势仍不明确。我们旨在比较锝-99m-半乳糖基人血清白蛋白闪烁扫描术与传统计算机断层扫描容积测量法对门静脉栓塞术后患者肝切除术后肝衰竭的预测能力。
这项回顾性研究分析了2006年至2021年间连续152例行门静脉栓塞术后肝胆癌切除术的患者。根据国际肝脏手术研究组标准对肝切除术后肝衰竭进行分级。比较锝-99m-半乳糖基人血清白蛋白闪烁扫描术测得的未来肝残余摄取率（%）与计算机断层扫描容积测量法测得的未来肝残余体积率（%）对肝切除术后肝衰竭的预测能力。
门静脉栓塞术后，未来肝残余摄取率（%）显著高于未来肝残余体积率（%）（47.9%对40.8%；P <.001），而在门静脉栓塞术前两者的值相当（32.7%对31.2%；P =.116）。受试者工作特征曲线分析显示，对于预测肝切除术后肝衰竭，门静脉栓塞术后未来肝残余体积率（%）的曲线下面积显著高于门静脉栓塞术后未来肝残余摄取率（%）（0.709对0.
