Perioperative hepatic functional risk assessed with technetium-99m diethylenetriamine pentaacetic acid-galactosyl human serum albumin liver scintigraphy in patients undergoing pancreaticoduodenectomy complicated by obstructive jaundice.

Abstract

CONCLUSION:

Liver scintigraphy with technetium-99m diethylenetriamine pentaacetic acid-galactosyl human serum albumin (Tc-GSA) can be used to predict outcome of biliary drainage and hepatic function after pancreaticoduodenectomy in patients with pancreatic, biliary, and ampullary carcinomas complicated by obstructive jaundice.

BACKGROUND:

Preoperative obstructive jaundice has been reported as a crucial risk factor for serious postoperative complications in patients undergoing pancreaticoduodenectomy. The aim of the present study was to investigate whether Tc-GSA liver scintigraphy can assess hepatic functional risk in patients with pancreatic, biliary, and ampullary carcinomas complicated by obstructive jaundice.

METHODS:

Liver scintigraphy was performed before biliary drainage in 18 patients with obstructive jaundice. The maximum removal rate of Tc-GSA (GSA-Rmax; standard normal value > or = 0.60) was calculated. These patients underwent pancreaticoduodenectomy with wide lymphadenectomy. The efficacy of preoperative biliary drainage was assessed with the decrease in serum bilirubin concentration in the first week after biliary drainage. Postoperative liver function was assessed with the increase in serum bilirubin concentration, which was the difference between the immediate preoperative and maximal postoperative bilirubin concentrations.

RESULTS:

Serum bilirubin decreased more in the first week after biliary drainage in patients with GSA-Rmax > or = 0.60 (7.64 +/- 1.09 mg/Dl/wk) than in patients with GSA-Rmax < 0.60 (3.56 +/- 1.25 mg/DL/wk, p = 0.042). Postoperative bilirubin increased less in patients with GSA-Rmax > or = 0.60 (0.81 +/- 0.30 mg/dL) than in patients with GSA-Rmax < 0.60 (4.00 +/- 0.69 mg/DL, p = 0.0012). Multivariate analysis showed that GSA-Rmax significantly predicted the postoperative bilirubin increase (p = 0.020).

• Authors: H Nakano, K Kumada, Y Takekuma, S Hasebe, Y Yoshizawa, M Yamaguchi, D Jaeck
• Journal: International journal of pancreatology : official journal of the International Association of Pancreatology (Int J Pancreatol) Vol. 25 Issue 1 Pg. 3-9 (Feb 1999) ISSN: 0169-4197 [Print] United States
• PMID: 10211415 (Publication Type: Clinical Trial, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Technetium Tc 99m Aggregated Albumin
• technetium Tc 99m DTPA-galactosyl-human serum albumin
• Bilirubin
• Technetium Tc 99m Pentetate

Topics

• Adult
• Aged
• Ampulla of Vater (pathology, surgery)
• Biliary Tract Neoplasms (complications, surgery)
• Bilirubin (blood)
• Cholestasis (blood, complications, diagnosis)
• Humans
• Intraoperative Period
• Liver (diagnostic imaging, physiopathology)
• Liver Function Tests
• Middle Aged
• Multivariate Analysis
• Pancreatic Neoplasms (complications, surgery)
• Pancreaticoduodenectomy
• Postoperative Complications (prevention & control)
• Prognosis
• Radionuclide Imaging
• Risk Assessment
• Technetium Tc 99m Aggregated Albumin
• Technetium Tc 99m Pentetate