Hepatobiliary scintigraphy and kinetic growth rate predict liver failure after ALPPS: a multi-institutional study.

Abstract

BACKGROUND:

Post hepatectomy liver failure (PHLF) after ALPPS has been related to the discrepancy between liver volume and function. Pre-operative hepatobiliary scintigraphy (HBS) can predict post-operative liver function and guide when it is safe to proceed with major hepatectomy. Aim of this study was to evaluate the role of HBS in predicting PHLF after ALPPS, defining a safe cut-off.

METHODS:

A multicenter retrospective study was approved by the ALPPS Registry. All patients selected for ALPPS between 2012 and 2018, were evaluated. Every patient underwent HBS during ALPPS evaluation. PHLF was reported according to ISGLS definition, considering grade B or C as clinically significant.

RESULTS:

98 patients were included. Thirteen patients experienced PHLF grade B or C (14%) following ALPPS-2. The HBS and the daily gain in volume (KGRFLR) of the future liver remnant (FLR) were significantly lower in PHLF B and C (p = .004 and .041 respectively). ROC curves indicated safe cut-offs of 4.1%/day (AUC = 0.68) for KGRFLR, and of 2.7 %/min/m2 (AUC = 0.75) for HBSFLR. Multivariate analysis confirmed these cut-offs as variables predicting PHLF after ALPPS-2.

CONCLUSION:

Patients presenting a KGRFLR ≤4.1%/day and a HBSFLR ≤2.7%/min/m2 are at high risk of PHLF and their second stage should be re-discussed.

• Authors: Federico Tomassini, Yves D'Asseler, Michael Linecker, Mariano C Giglio, Carlos Castro-Benitez, Stéphanie Truant, Rimma Axelsson, Pim B Olthof, Roberto Montalti, Matteo Serenari, Thiery Chapelle, Valerio Lucidi, Ernesto Sparrelid, René Adam, Thomas Van Gulik, François-René Pruvot, Pierre-Alain Clavien, Dario Bruzzese, Karen Geboes, Roberto I Troisi
• Journal: HPB : the official journal of the International Hepato Pancreato Biliary Association (HPB (Oxford)) Vol. 22 Issue 10 Pg. 1420-1428 (10 2020) ISSN: 1477-2574 [Electronic] England
• PMID: 32057681 (Publication Type: Journal Article, Multicenter Study)
• Copyright: Copyright © 2020 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.

Topics

• Hepatectomy (adverse effects)
• Humans
• Liver (diagnostic imaging, surgery)
• Liver Failure (diagnostic imaging, etiology)
• Liver Neoplasms (diagnostic imaging, surgery)
• Portal Vein (diagnostic imaging, surgery)
• Radionuclide Imaging
• Retrospective Studies